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CITY OF EDMONDS 7 NUMB8901.62
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CONSTRUCTION PERMIT APPLICATION
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CITY TELEPHONE NUMBER PUBLIC RIGHT//OF WAY PER OFFICIAL STREET MAP. APPROVED BY
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ADDRESS .—F,USE PERMIT REQUIRED:
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NAME
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ALLOWED PROPOSED COMPLETE E%EMPT
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Legal Description of Properly • Include all easements
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(show below or attach copies) SNORELeJE1
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VARIANCE OR N,U PLANNING REVIEW 8Y OATE
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NEVI RESIDENTIAL PLUMBING
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REPAIR RETAINING WALL I—J SIGN
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INSERT APT.SLDG RENEWAL REMARKS
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PROGRESS INSPECTIONS PER UBC 305
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO BE DONE /ATTACH PLOT PLAN)
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BUILDING —J
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This Permit COv6rs work t0 be done on private properly ONLY, GRADINGWILL
Any construction on the public domain (curbs, sidewRlkl,"
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE ��
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Perml! Application: 180 Days
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ENERGY CODE
Permit Limit: i Year- Provided Work Is Started Within 180 Days _
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"Applicant, on behalf of his or her spouse, heirs, assigns and
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successorD in Interest, agrees to Indemnify, defend and hold
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harmless the City of Edmonds, Washington, its oflicials,
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and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the Issuance —Ito)
of ;his Issuance of this be deemed PUN CHECK DEPOSIT o
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permit. permit shall not to Vw1t,f'
modify, waive or reduce any rbquiroment of any city ordinance
nor limit In any way the City's ability to anlorce any ordinance e
TOTAL AMOUNT DUE
provision."
hereby acknowledge that I have read this application; that the
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foi oration given is correct; and that f am the owner, or Y" duly ATTENTION APPLICATION APPROVAL
a'Ithe,I ad agent of the owner. I agree to Comply with city and
THIS PERMIT
stLIQ la:'s rr0aUefing construction; and in doing the workau horiz- AUTHOF12 S This application Is not a permit until
by the Building Official
ed In erel,,, no pbrson will be Employed In violation of the Labor ONLY THE signed or his
Code if thiState of Washington relating to Workmen's Cornpenia- WORK NOTED Dnputy; and fees are paid, and receipt is
Ii o Ins Uan6Y. INSPECTION acknowledged in space provided.
stGriA1URE
'O'Ii N.'H OR AGEnt;I DATE SIGNED DEPARTMENT
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EDMONDS
ATTENTION
71 32 RELEASED Y OA E
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UNLAWFUL TL USE OR OCCUPY A BUILDING OR STRUCTURE
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UNTIL
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A FINAL INSP; OTILN HAS BEEN. MADE AND APPROVAL OR
CERTIFICATE OF OCCL FANCY HAS BEEN GRANTED, UBC ORIGINAL — File YELLOW — InspeclD
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CHAPTER
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0. PINK — Owner GOLD — Assessor
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