970444 (2).pdfM
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ZONE PERMIT
NUMBER'70QI�4
JOB ^ ^ �,�jj�Cr APT u
ADDRESS S �/,j5 "F . J
OWNE �rNfA/A1E'NAME OF B SINESS
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LEGAL DESCRIPTION .."I SUBDIVISION NO
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PUBLIC R
FIGHT OF WAY PER OFFICIAL $TPEEi MAP
EXI$tINO gEOUIRED DEDICATION
TESCP Approved ❑
RW 01 USO P-11Fd ❑
. Si'Ol Ufs Permll Regd ❑
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PROPOSED
Inspecllon Requ,red ❑
Sldewflk Requged ❑
NAME
METER 512E
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES D NO ❑
W
ADDRESS
¢
REMARKS
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CITY ZIP
TELEPHONE NUMBER
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NAME
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ADDRESS
ENGINEERING MEMO DATED REVIEWED BY
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CITY ZIP
TELEPHONE NUMBER
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I
IRE MEMO DATED REVIEWED BY
E%PInATST?—gS LYfDATE
VARIANCE OR CU
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SHORELINE N
Legal Description of Property - include all easements
SERA REVIEW
COMPLETE
E%P
EXEMPT
SIGN
ALLOWED
AREA
PROPOSED
HEIGHT
ALLOWED
PROPOSED
ZO
-
H
p
LOT COVERAGE
ALLOWED PROPOSED
REOUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT LIP SIDE REAR O,
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Tex ACcoanl /�f IIO0— 7.�CO06
Parcel No. 3 (/ V �+
LOT AREA
PLANNINGREVIEWBY
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DATE a
NEW 0RESIDENTIAL PLUMBINGIMECH
REMARKS
'yyy�f��'
„ 10,0 V
�AODITION COMMERCIAL CHANGE OF USE
REMODEL APT' SLOG. SIGN
CHECKED BY TYPE OF CONSTRUCTION COD
GRCOUPANT
coos.
REPAIR ❑ GRADING ❑ ; ENCE K—�
DEMOLISH ❑ NSERT TOVE HOTMMTUBSPA
GARAGE RETAINING WALL/ �Q�
CARPORT ROCKERY ® IINEWAL
REQUIRE° SPECTOR
❑YES
AREA
GOAD PANT
EMARK.S
-
PROGRESS INSPECTIONS PER UBC 108
(TYPE OFUsVMESS OR ACTIVITY) EXPLAIN:
CS
m
'x
O
NUMBER
NUMBER OF
DWELLING
ICRICAL
AREAS q
mo
STORIES
STORIES
UNITS
NUlABER / 7
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
V1 h 0A/_r LW O S G
FINAL INSPECTION REQUIRED
Ml le r/
/•� F'
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE
GLAZING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any Construction on the public domain (curbs, sldewelks,
STATE SURCHARGE
driveways, marquees. etc.) will require separate permission.
Pem l Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalI of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
w
s
a
°
°
successors in interest, agrees to Indemnity, defend and hold
harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages or
whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit In any way the Clty's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this appilcallon; that the
information given is correct; and that I am the owner, or the duly ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
slate laws rag ulet1ng construction; and In doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed In violation of the Labor ONLY THE
This application Is not a permit until
signed by the Building Official or his/her
Code or the State of Washington relating to Workmen's Compensa- WORK NOTED
Lion Insurance aria RCW 18.27. INSPECTION
(OWNER OR AGENit DATE SIGNED DEPARTMENT
Deputy; and fees are paid, and receipt Is
acknowledged In space provided.
OFF( I L' I NAIURE DATE
S
LSIURI
CITY OF
�---� EDMON DS
ATTENTION CALLFOR
INSPECTION
LEASE DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� �oGGo
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A r]P RTI FICATE nF ncOUPANCY HAS BEEN GRANTED. UBC
ORIGINAL — File YELLOW — Inspector
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SECTION 109 PINK — Owner GOLD — Assessor
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