820142.pdfIS
USE PERMIT
CITY OF EDMONDS ZONE NUMeEN
CONSTRUCTION PERMIT APPLICATION oa
• NAME (OR NAME OF BUSINESSI AOUNES5
LEGAL. OESCIiIPI�?jNECK IiVBOIVI.iIUN
MAILING ADD S5
CI Y/ TELEPHONENUM9EP PUBLIC FIGHT OF WAY PER OFFICIAL STIIEEt MAP
/� /� 'lr '�� ' EXISTING REOUIREO DEDICATION
PROPOSED
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TELEPHONE NUMBER
7-1
TATE LICENSE NUMBER
CITY LICENSE NUMBER
nnnl n<cn-fin unn Df Fonertv. include
all easements
820142
RIGHT OF WAY CONSTRUCTION PERMIT REOUI D
STREET USEPERMIT REQUIRED
SEE ENGINEERING MEMO OA tEO_. _.._------------
SEE PIW DEPT REVIEW CHECK LIST._ATEU
SIGN AREA ENV. REVIEW nv nu-
ALLO ALLOWED PROPOSED/ COMPLETE EXEMPT -�I Z
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VARIANCE OR CU PL NO EVIE D�A/T
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NEW
RESIDENTIAL
PLUMBING
ElADDIALTER
NON-RESIDENTIAL
MECHANICAL
RETAINING WALL
"'SIGNEXCA
REPAIR
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
❑ FENCE
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ElDEMOLISH
OR FIILLTE
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INSPJ
SWIM
SPECIAL INSPECTOR EA OCCUPANCY OCCUPANT
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❑PRE•MOVE
COMPLIANCE INSP.
O POOL
REQUIRED GROUP LOAD
SIDE SEWER
WATER LINE
El
YES NO
REMARKS l7
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VUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE/(ATTACH PLOT
— . /- 11
VALUATION
Ftt
/ PLAN CHECK FEE
(BUILDING
ell PLUMBING
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.
S 00
OO
Permit Application: 180 Days
Permit Limit: 1 Year- Provided Work Is Started Within 180 Days
llIpplicant, on behalf of his or her spouse, heirs, assigns and
a successors In Interest, agrees to Indemnify, defend and hold
W harmless the City of Edmonds, Washington, Its officials,
i employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the Issuance
m 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 City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the ATTENTION
Information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT
slate laws regulating construction; and In doing the work authoriz• AUTHORIZES
ed thereby, no person will be employed In violation of the Labor WORKNOTETHEDNOTED
of tha St to of Washington relating to Workmen's Compensa•
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his
Deputy; end fees are paid, and receipt Is
acknowledged In space provided.
nsur INSPECTION
LSIGNATU 1 N DAT N D� DEPARTMENT
1�
CITY OF
OFF L'S SIGNATURE /
_ _ YT
THIS SITE IS LOCATED IN THE CITY EDMONDS
k
O aa/
DA
20
OF EDMONDS. LOCAL SALES TAX 775-2525
ATTENTION SHOULD BE CODED 31,04.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
ORIGINAL — File YELLOW — 111spoclor
PINK — Owner GOLD — Assessor
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CHAPTER
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Retaining walls I \L
Garage, carport
Of I PMBING
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Rough -In
Water service
HEATING SYSTEM —
FRAMING
WALLBOARD
FINALi�-
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