830232.pdfCITY OF EDMONDS DOE PERMIT 8
r _ ZONE NUMBER 312`
RUCTION PERMIT APPLICATION ICONS
CONS 7
r ::y OF BUSINESS) ADDRESS 1
NAME (Ofl NAMt`e
LEGAL DESCRIPTION CHECK SUBDIVISION NO.1 ID NO.
-- Z MAILING ADDRES,.I/ .,I"a"
CITY LICENSE NL
all easements
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING__.__ REQUIRED DEDICATION
PROPOSED__.
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED: 1
STREET USE PERMIT REQUIRED I.,
F."c
SEE ENGINEERING MEMO DATED _.
SEE PIW DEPT. REVIEW CHECK LIST DATED
REMARKS /
Alo
UNITS
SIGN AREA
ENV. REVIEW
ADD NO.
ALLOWED
PROPOSED
COMPLETE
EXEMPT
I� 1
I
SHORELINEN
i� VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
LOT
COVERAGE
FRONT SIDE
REAR
i
a'
L NEW u RESIDENTIAL
ADDIALTER [NON-RESIDENTIAL
IEl
REPAIR RETAINING WALL
EXCAVATE
DEMOLISH ZOR FILL
❑PRE -MOVE INSP.I
COMPLIANCE INSP.
L� PLUMBING
MECHANICAL
SIGN
FENCE
f-%-_FT1
SWIM
POOL
CHECKED BV TI
SPECIAL INSPECTOR
REQUIRED
• SIDE SEWER O WATER LINE
I YES NO
REMARKS
0
1 �t�QO n
rUMBER OF STORIES
NUMBEROF
DWELLING
UNITS
JATURE OF WORK TO BE DONE fATTACH
PLOT PLAN)
PLAN CHECK FEE
BUILDING
PLUMBING
/ MECHANICAL
This Permit covers work to be done on private properly 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
N successors in interest, agrees to Indemnify, defend and and
w harmless the City of Edmonds, Washington, its officials.
employees, and agents from any and all claims for damages of
iwhatever nalure, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
0
modify, waive or reduce any requirement of any city ordinance
0. 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 ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
tion Insurance. INSPECTION
IGNATURE PWt1ER OR AGEN �,�., DATE SIGNED DEPARTMENT
CITY OF
` THIS SITE IS LOCATED IN THE CITY EDMONDS
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
CHAPTER 3.
70248
GROUP
VALUATION
LOAD
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt Is
acknowledged in space provided.
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
ij '
3
yr:
1
1
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i
• - ,.: ..
.
RECORD OF INSPECTIQNS,
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..Dafe Pa"s'sed' i
-2 W..
FOUNDATIOR
_
House
Porches, piers ----
— - — —.
Retains n v eillg _
Garage, carport
PLUMBING —
a
Underground- -
-- a
RouPh in ---
__..
Water service'
_
HE ATING'SYSTEM.
i�
FRAMING
WALLBOARD
'FINAL
-