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USE PERMIT
CITY OF EDMONDS ZONE NUMBER ✓r 61 `h ' '
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CONSTRUCTION PERMIT APPLICATION OB sUITE/APTn
OWNER NAME/NAME OF BUSINESS ADDRESS S , ..- Ja - P , L-2
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LEGAL CHECK SUBDIVISION NO. LID NO
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ADDRESS 4'�P`" 1161
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PUOLIC PIG T OF WAY PER OFFICIAL STREET
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED w
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5 � //� C ! j 2- Zy 0 SIGN AR`EA'WLl ENV. REVIEW r ADr 8_NO.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
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SETBACKS - FEFSIDE HE LOT COVERAGE
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Tax Account Parcel No.
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NEW RESIDENTIAL PLUMBING
ADD/ALTER COMMERCIAL MECHANICAL
APT. BLDG. S / S '�,.s"liJy¢iI�S ZIS S-
REPAIR SIGN
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EXCAVATE, FILL FENCE CHECKED V TYPE ONSTRUCTION N C111 HEIGHT
DEMOLISH OR GRADE�[.'r1�L
CARPORT El SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REMODEL GARAGE POOL IRED GROUP }r/ 7 LOAD
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INSERT ❑ RENEWAL E ARKS t", NO
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 Z
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) / j[JFI!//P}� 4�' I asm
FINAL INSPECTION REQUIRED
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VALUATION FEE
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PLAN CHECK FEE 5m,66
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Plan Check No. �4-MECHANICAL
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This Permit covers work to be done on private property ONLY. cRADINGrFaI
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE 5
Permit Application: 180 Days
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Permit Limit: 1 Year- Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
wsuccessors
in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials, p p.��
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semployees, and agents from any and all claims for damages of : F--A(rp'a
a whatever nature, arising directly or Indirectly from the issuance
= of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT.
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE^
provision."
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
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Information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz• AUTHORIZES
ed thereby, no person will be employed In violation of the Labor ONLY THE signed by the,Building Official or his
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ode of the State of Washington relating to Workmen's Compensa- WORK NOTED eputy; and fedsaee paid, and receipt is
in space provided.
tl n Insurance. INSPECTIONacknowledged
DATE SIGNED DEPARTMENT
OFFICIAL'S SGN1RE DATE
MWNTI
CITY OF -
0 L rQ EDMONDS
RELE EG : ^ DATE .
CALL FOR
ATTEN
ION INSPECTION
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UNTIL
IS UNLAW L TO U E OR OCCUPY A BUILDING OR STRUCTURE 771-3202
A FINAL PEC ION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
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CHAPTER
CERTIFICATE O CCUPANCY HAS BEEN GRANTED. UBC /
3.�c� PINK — Owner GOLD — Assessor
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