830417.pdfCITY OF EDMONDS USE
NUMBER
83041�
CONSTRUCTION PERMIT APPLICATION `'
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NAMF. (OR NAME OF BUSINESS / ADDRESSr�-7�—•fy�
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J� C ,;`; _, ,! % J f.,,r�, LEGAL DESCRIPTIOtJ CHECK SUBDIVISION WU. LID NO.
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CITY F 1 TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
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I +.'/�rt �� .4�i I l ;r ". . ' _ EXISTING ".__...._. _. ... REQUIRED DEDICATION ._
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED. W j
H ADDRESS STREET USE PERMIT REQUIHED (W9 fV ..
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REMARKS ---
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NAME
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CITY TELEPHONE NUMBER w j
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SIGN AREA ENV REVIEW Ace NO,
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - include all easements
(show below or attach four copies) SHORELINE a
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q VARIANCE (it7 r;U PLANNING REVIEW BY PATE
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YARDS LOT COVERAGE z
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NEW RESIDENTIAL PLUMBING
ADD/ALTER 14ON-RESIDENTIAL MECHANICAL --
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REPAIR RETAINING WALL SIGN i
EXCAVATE FENCECHECKED BY iiYP:: OF CONSTRUCTION CODE HEIGHT I
DEMOLISH R OR FILL (.. FT)
❑ PRE -MOVE INSP.i ❑ SWIM
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
COMPLIANCE INSP. POOL REQUIRED GROUP LOAD
YES NO
SIDE SEWER WATER LINE REMARKS O
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W NUMBER OF STORIES NUMBEROF
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) -! i
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VALUATION FEE t
PLAN CHECK FEE ,
BUILDING
PLUM0BING
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This Permit covers work to be done on private property ONLY. GRADING ='LL
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 lNithin 180 Days
"Applicant. on behalf of his or her spouse, heirs. FSS:cns and
successors I" interest, agrees to Indemnifydefend and hold
w harmless the City of Edmonds. Washington. It= officials,
employees, and agents iron) any and all claims for Jamages of
whatever nature, arising directly or indirectly from the issuance
of this permit Issuance of this permit shall not ,Teemed to
modify, waive or reduce any, requirement of ar,y :,i;y 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 acoh.-ation: that the
information given is correct: and that I am the o:vncr. or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply ;',rth city and c oERhrr
state laws regulating construction: and in doing the'rrork authorize r- ar_Es This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ,r,L' T,r signed by the Building Official or his
Code of the State of Washington relating to `.ti'orkmen'S Compensa- °'"HK r,Q�Eu Deputy: and fees are paid, and receipt is e:
tien Insurance, acknowledged in space provided.
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SIGNATURE 0 NER QR AG'_^)r! ART 4,+E_;7
,.�_a{ :../ / •„� i ";,-.._..._ .__. OFF( ACS SIGNATURE
CITY OF i
THIS SITE IS LOCATED IN THE CITY EDMONDS
OF EDMONDS- LOCAL SALES TA;Y• DATE]
ATTENTION SHOULD BE CODED 31.0: ''52525
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN !:LADE 4 ND APPROVAL OR ORIGINAL — Fife YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS E.EEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
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