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CITY OF EDMONDS
-CONSTRUCTION PERMIT APPLICATION
.1 OWNER NAME/NAME OF BUSINESS
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W MAILING ADDRESS
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ADDRESS
CITY ZIP ITELEPHONE
ADDRESS
-7
ZIP TELEPHONE NUMBER
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STATE LICENSE NUMBER EXPIRATION DATE
_3-V,,�J.D
Legal Description of Property - include all easements
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Tax Account
60 A 0 0 3
Parcel No.
F]
NEW
RESIDENTIAL
PLUMBING
ADDITION
COMMERCIAL'
MECHANICAL
REMODEL
1:1 APT. BLDG.
El SIGN
�?REPAIR
GRADING
El CYDS.
FENCE
I
DEMOLISH
—
WOODSTOVE
INSERT
x _FT)
SWIM POOL
HOT TUB/SPA
GARAGE
C
RETAINING WALU
ROCKERY
RENEWAL
(TYPE OF,USE. BUSINESS OR ACTIVITYJ EXPLAIN
/1, 4, S ( �J. e -) 11 , " A.. I
NUMBER NUMBER OF CRITICAL
OF NG
OWELLI AREAS
STORIES UNITS I I NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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HEAT
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ZONE PERMIT
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SUITE/AF
ADDRESS
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved
13
EXISTING — REQUIRED DEDICATION
RW Permit Required
11
—
Street Use Permit Req'd
13
Inspection Required
0
PROPOSED
Sidewalk Required
0
METER SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
REMARKS
ENGINEERING MEMO DATED REVIEWED BY
SIGN AREA SEPA REVIEW AOB NO.
ALLOWED I PROPOSED I COMPLETE IEXEMPT I
N
I I EXP
VARIANCE OR CU
I PLANNING REVIEW BY DATE
SETBACKS — FEE . T HHT1 I LOT COVERAGE
FRONT SIDE REAR
L;HLCKE0 BY TYPE OF CONSTRUCTION CODE OCCUPANT
GRop
57y
SPECIAL INSPECTOR
OCCUPANT
REQUIRED 13 YES LOAD
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
GLAZING
PLUMBING
Plan Check No. (2—g —6 C? MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewplks,
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 ��A&USW 7
D successors in interest, agrees to indemnify, defend and hold —
J harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
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
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or thp duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
9 ' tate 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
tion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGNAT'LlflE (0 NER OR AGENT) DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
O�Fl C GN,, DATE
ATTENTION
CALL FOR
RELEASP Bt.,,�, 16ATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
_UBC
CHAPTER 3.
102-87
4'r
PINK — Owner GOLD — Assessor
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