820295.pdfs
USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION ,Oe
NAME tOR NAME OF BUSINE551 ADDRESS
` S LEGAL DE
MAILING ADDRESS
/ ,fl Hit .7 6 YMr'/c r-ACJ ✓ L7,C/!� "
NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
- 7.-1 J j EXISTING REOUIREDDEDICA710N
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REOUIRED
STREET USEPERMIT REQUIRED
SEE ENGINEERING MEMO UATEU------------
NUMBER SEE PIW DEPT REVIEW CHECK LIST DATED .... .. . .... ..
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Y SIZE
CITY LICENSE NUMBER
820295)
SIGN AREA ENV. REVIEW ADO NO.
ALLOWED PROPOSED COMPLETE EXEMPT
all easements SHORELINE
oil, rc he - VARIANCE OR CU PLANNING REVIEW BY DATE
LOT COVERAGE
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FRONT
REMARKS
yV 8¢
FT Oi
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❑
®
❑
NEW
RESIDENTIAL
PLUMBING
❑
❑
ADDIALTER
NON-RESIDENTIAL
MECHANICAL
® ❑
RETAINING WALL
❑ SIGN
REPAIR
❑ ❑
EXCAVATE
FENCE �j
❑
CHECKED BY TY
DEMOLISH
OR FILL
(—xr7._FT)
❑
SWIM
❑ 1,
SPECIAL SPFCTOR
❑ SIDE SEWER ❑
COMPLPRE-MLIIANCE INSNSPJ P.
WATER LINE
PO
❑
REQUIRED
:'.YES NO
REMARKS
I NUMBER OF STO.—
c DWELLING
m UNITS
101
NATURE Of WORK TO BE DONE (ATTACH PLC
12rOA/P A.vn i
PLAN CHECK FEE
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BUILDING
f 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.
Permit Application: 180 Days
Permit Limit: 1 Year • Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors In interest, agrees to indemnify, defend and hold
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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 permlt shall not be deemed to
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modify, waive or reduce any requirement of any city ordinance
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nor limit In any way the Clty's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
1 hereby acknowledge that I have read this application; that the ATTENTION
APPLICATION APPROVAL
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
This application is not a permit until
state laws regulating construction; and In doing the work authoriz•
AUTHORIZES
signed by the Building Official or his
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a thereby, no person will be employed In violation of the Labor
ONLY THE
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa•
acknowledged in space provided.
tl n Insurance.
INSPECTION
$1 TUBE IOW7R OR GENT DATE IGNEO
OEPARrMENT
OFFICI L'S SIGNATURE
Z
CITY OF
EDMONDS
•.
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. EDMONDS. LOCAL SALES TAX 775.2525
DATE
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 1' (L. r7.
'it;�ryjJRIGINALL— File YELLOW —Inspector
e• i,
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC J U
PINK — Owner GOLD — Assessor
CHAPTER 3.
102 78
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- RECORD OF INSPECTIONS
-
...Date Passed
FOUNDATION
House
--
Porches, piers. -• --
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Retain.ing walls
Garage; carport ` -•- -• —
+� PLUMBING ----=------"'
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Underground -•-- — -
Rough -in -
Water service
HEATING SYSTEM
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