930177.pdfCITY OF EDMONDS DOB
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CONSTRUCTION PERMIT APPLICATION aoa
OWNER NAME NAME OF BUSINESS ADOR
f / .l L•' �-/ m L'+� C LEGAL
ZMAILING ADDRESS
PERMIT
NUMBER
CI v 1 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
21P TELEPHONE NUMBER RW Permil Requueo ❑
//••�� l EXISTING REQUIRED DEDICATION Sueei Lee Permit Req'd ❑
7 4 �. - r �/ PROPOSED leapeeti0n Required ❑
/ Sidewalk Required ❑
REMARKS
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CITY ZIP TELEPHONE NUMBER
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REMARKS
STATE LICENSE NUMBER EXPIRATION DATE
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SIGN AREA SERA REVIEW ADD NO.
Legal Description of Property - include all easements
ALLOWED PROPOSED COMPLETE
l:Lq
JEXEMPT
SHORELNEMp
I EXP
VARIANCE OR cu PLANNING REVIEW BY DATE
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SETBACKS — FEET HEIGHT LOT COVERAGE
Property
FRONT SIDE REAR
Tax Accou n!
Parcel No. .�� - '1 (, � - O C 3 O d +� �+
REMARKS
P9,NEW � RESIDENTIAL PLUMBING
'
OADDITION COMMERCIAL MECHANICAL
REMODEL APT. BLDG. SIGN
❑GRADING rj't F �
CHECKED BY TYPE OF�CONSTRUCTION CODE HEIGHT,
REPAIR CYDS. (� F73
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ElDEMOLISH❑ INSER STOVE HOT TUBI6PA
AREA PANT
GARAGE WALL/ El
REOUIREDNSPECTOR
GROUPANCY
TOAD
YES
CARPORT ROCKERY RENEWALREMARKS
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 305
to
NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
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DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
(rL! %,9„zf / x l / C.,._ ��
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VALUATION FE1,6v.
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PLAN CHECK FEE
HEAT SOURCE; GLAZING
BUILDING
PLUMBING
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Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, On behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
w successors in interest, agrees to indemnify, defend and hold
ur harmless the City of Edmonds, Washington, Its officials,
eemployees, and agents from any and all claims for damages of
i 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 DUEprovision."
1 hereby acknowledge that I have read this application; that the
information given is correct; and that 1 am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
ti n Insurance.
INSPECTION
acknowledged in space provided.
SIGNATURE 10 raE OR AGE NTI. GATE SIGNED
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J`�-'1.�L-
DEPARTMENT
CITY OP
'S GNA DAt
�,t. 't-i--!-/
EDMONDS
AA'S
ATTENTION
CALL FOR
RE D . DATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
INSPECTION
771-0220
UNTIL A FINAL HAS BEEN MADE AND APPROVAL OR
ORIGINAL - File YELLOW - Inspec r
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
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CHAPTER 3.
tat 87
PINK - Owner GOLD - Asses r
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