910906.pdfr
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ITE/APT4
[, — ,,� `�*"L' 4
OWNER NAM11E'NAME OF BUSINESS ADDRESS V
/ t J � �-1 - DESCRIPTION CHECK SUBDIVISION NO LID NO
w MAI/LING AO/DRESS /{1�'/`
Z c/`ys, by
3 �j rj c,---_ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. RWPeTESCP Approved ❑
' O PW Permit Required ❑
t;iTy ZIP TELEPHONE NUMBER EXISTING _ REQUIRED DEDICATION CWaStreet Use Permit Rem it❑
[.L_� — f z" Inspection Required ❑
7 PROPOSED SItllk Requ'mIuneretl ❑ Z
NAME C
REMARKS
z
w ADDRESS Z
w
CITY ZIP TELEPHONE NUMBER
NAME
ENGINEERING MEMO DATED REVIEW BY It
ADDRESS METEfl SIZE BUILDING SUPPLY SIZE NO. OF FIXTURES
O ¢
O ZIP TELEPHONE NUMRER w
clTv i
z
REMARKS
O
O STATE LICENSE NUMBER
SIGN AREA SEPAREVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - include ail easements SHORELINE «
z 0' y-' EXP
0
% f VARIANCE OR CU NNI VIEW BY Z. f� ATE
p y 1 SETBACKS — FEET HEIGHT LOT COYERAG z
it Gi— z
a lE C-4 /I, �� FRONT �"'— SIDE REAR g
O
Tax Account Parcel No. REMARKS
NEW J RESIDENTIAL PLUMBING
ADDIALTER //❑ COMMERCIAL (�j MECHANICAL
APT. BLDG. El SIGN
REPAIR FF CHECKED BY TYPE OF CONSTRUCTION HEIGHT
( rx
El DEMOLISH Q GRADING CYDS. 't
���FFF
REMODEL CARAGET swim POOL BE RED INSPECTOR AREA OCCUPANCY OCCUPANT
GROUP LOA
y!n/_ D
❑YES 'T
❑ WOOD STO
INSERT ROCKERY VE/ ❑ RETAINING WALL{ D RENEWAL REMARKS t7
PROGRESS INSPECTIONS PER UBC 305 z
z 5
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: to
to
a
NUMBER OF STORIES NUMBER OF
wo DWELLING
se UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN),
131 i vt E FINAL INSPECTION REOUIRED
VALUATION FEE
PLAN CHECK FEE
BUILDING S�
I
PLUMBING
Plan Check No. MECHANICAL
This Per it covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days STORM DRAINAGE FEE
Permit Limit:1 Year - Provided Work is Started Within 180 Days ;
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
in
1.
harmlessrihe ICityeof Edmonds,IDWashington,faits officals
employees, and agents from any and all claims for damages of !�
swhatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
of this permit. issuance of this permit shall not be deemed to
9 modify, waive or reduce any requirement of any city ordinance DUE j
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT
provision."
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL I�
information given is correct; and that I am the owner, or the duly application is not a permit until
authorized agent of the owner. I agree to comply with city and THIS PERMIT This
state laws regulating construction; and in doing the work authoriz• AUTHORIZES signed by the Building Official or his/her �.
ed thereby, no person wlll be employed in violation of the Labor ONLY TH
WORK Norco Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa- INSPECTION acknowledged in space provided.
tion lnsBranDe. DATE SIGNS DEPARTMETE
NT
SIGNATURE )OWNER OR AGENT) P OFFICI GNATUR ,DA
CITY OF
Lt�-
EDMONDS A �
A ATE
CALL FOR RELEASED By
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202
ORIGINAL — File YELLOW —Inspector
' UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC PINK — Owner GOLD — Assessor: ..i
CHAPTER 3.
1e2 87
Economy Fence Center, Inc. BID DATE: ��' � � �! /
I:j,
f-k 133255 Lake Road SET DATE l�-` ��^ POWER 0.VAltA8lE7. prYEB ONO
Lynnwood, WA 98037-1619 CREW _'r(h4 "!IP i. WATER AVAILABLE? IVYES ONO
1 Everett: 347-1355 COMPLETE ON -: 1 COST ANIMAL
MEET
CREW?
❑YES 0NO
�+ CREW .I1� CUSi TO MEET CflEWt `WE5 ❑NO
� d � Seattle: 447-1536 SALES REPWICREW7 ❑YES VNO
f!� . 1Z. Eastside: 881-0884
l r i,.. A WASHINGTON CORPORATION EC-ON-OF-CI48OF - VEVsrett347.1355 O Sssttle447.1538 0/Eastsido881-0384
SALESPERSON 5`.it�y�1��/IQ
CALL GARY W ELSORN TO SCHEDULE YOUR INSTALLATION BATE{SI.
c t1dn f tail,. �tde,l���r' �►��LLt3 0
lbli5 '%�arrl PIrIcr. UJs�.— e
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E r i►A AI tll� �I G2!? E
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WORK
PHONE NUMBERS: HOME11eKne�� Ott- COUNTY, PAGE GRID
7l�Sth i�4?i tl. tT 'Ti1C PG.IVF_WA5
LOCATE NO. {kiWXWDpL.,� iL:Ai tt rf DEPOSIT RECEIVED ❑ YES �NO
T AMIPM INSIDE CITY LIMITS? WYES ❑ NO
RCC&i�A �32.5a ,
�� c�;�l212 Iyt1G'
i
%710/0 WSST:
TOTAL: