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CONSTRUCTION
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LEGAL DESCRIPTION
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SUBDIVISION NO
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PUBLIC RIGHT
EXISTING
OF WAY PER OFFICIAL STREET MAP
—REQUIRED DEDICATION
TESCP Approved
RIN Permit Required
Street Use Permit Req'd
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CITY ZIP TELEPHONE NUMBER
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PROPOSED
Inspection Required
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NAME
Sidewalk Required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
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STATE LICENSE NUMBER EXPIRATION DATE
Legal Description of Property - include all easements
Property
Tax Account
Parcel No.
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PLUMBINGIMECH
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RESIDENTIAL
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COMPLIANCE OR
CHANGE
ADDITION
COMMERCIAL
OF USE
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FIREPAIR E] CYDS.
FENCE
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DEMOLISH WOODSTOIE
INSERT
SWIM POOL
HOTTUBISPA
GARAGE RETAINING WALL/
CARPORT ROCKERY
RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY). EXPLAIN:
—INUMBER
N UMBER NbMBER OF
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CRITICAL
AREAS
STORIES UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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VARIANCE OR CU ADB # SHORELINE N
SEPA REVIEW SIGN AREA HEIGHT
COMPL EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED I PROPOSED FRONT SIDE REAR FRONT IJR SIDE REAR
REMA
PLANNING REVIEW BY
D BY ITYPE OF CONSTRUCTION
SPECIAL INSPECTOR AREA
REQUIF
RED
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
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Plan Check No.
MECHANICAL
GRADINGWILL
This Permit covers work to be done on privafe property ONLY.
Any construction on the public domain (curbs, sidewpiks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
.
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINA GE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
'.n harmless the City of Edmonds, Washington, its officials,
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m employees, and agents from any and all claims for damages of
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< whatever nature, arising directly or Indirectly from the issuance
X 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
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TOTAL AMOUNT DUE
provision."
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I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
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
Code of the State ofWashington relating to Workmen's Compensa-
WORK NOTED
tion Insurance aria RCYrA8.27.
INSPECTION
INNER OR.$�`!_N N
DEPARTMENT
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CITY OF
EDMONDS
CALLFOR
ATTENTibN
INSPECTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE
FINAL INSPECTION HAS BEEN MADE AND APPROVAL. OR
771-0220
UNTIL A
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
102-87
FEE
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
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ORIGINAL
— File
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PINK —
Owner
GOLD —
Assessor
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RECORD OF INSPECTIONS