830472.pdfCITY OF EDMONDS
i CONSTRUCTION PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS)
PERMIT
NUMBER 83U472
[PUII.ILIC RIGHT OF WAY PER OFFICIAL STREET MAP.
ING REQUIRED DEDICATION
OSED ._._.._..
T OF WAY CONSTRUCTION PERMIT REQUIRED I !
ET USE PERMIT REQUIRED!
ENGINEERING MEMO DATEDPIW DEPT. REVIEW CHECK LIST DATED _._.. .—._
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THIS SITE IS LOCATED IN THE CITYOF EDMONDS.
ATTEN ON SHOULD BE COD DCAL 31.04.ALEBTAX 775.2525 DATE "I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE.�I
CITY LICENSE NUMB
LJ NEW
IJ RESIDENTIAL
U PLUMBING
❑ ADDIALTER
❑ NON-RESIDENTIAL
❑ MECHANICAL
❑ REPAIR
❑ RETAINING WALL
❑ SIGN
FENCE
El DEMOLISH
_EOXCAV `TE
❑ x __FT)
r-1 PRE -MOVE INSPJ
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SIGN AREA
ENV. REVIEW
ADB NO,
ALLOWED
PROPOSED
COMPLETE
EXEMPT
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SHORELINEN
DATE
VARIANCE OR CU
PLANNING REVIEW BY
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LOT
COVERAGE Z
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FRONT SIDE
REAR
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IJ COMPLIANCE INSP.
LI POOLJ.REQUIRED
GROUP
❑ ❑
❑ES
" NORKS
SIDE SEWER WATER LINE
❑IUMBER
OF STORIES
NUMBER OF
�JCF%T -10
C.11 — Ft
DWELLING
UNITS
JATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
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
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 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
proSision." _
I hereby acknowledge that 1 have read this application; that the
Information given Is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state 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 Sta of Washington relating to Workmen's Compensa-
WORK NOTED .
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tien I Sur ce.
INSPECTION
SIGNA E O N AGENT7 IDATE SIGNED
DEPARTMENT
®
CITY OF
EDMONDS
VALUATION
OCCUPANT
LOAD
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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.
ANTIL CERTIFICATE A FINAL NOFECO CU ANCYTION HAS BEEN HAS ABEENDE N GRANTED.ALUBC Mj1,YJ � •RIGINAL — File YELLOW —Inspector
CHAPTER 3. PINK — Owner GOLD — Assessor
102-78
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RECORD
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FOUNDATION
Dat'�assed
House
Porches, ie '
A rs
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Retaining walls -
— —
Gara�e; carport —
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PLUI ING
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Underground
Rough;in '
Water service
HEA7ING.SYSTEM
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FRAMING
WALLBOARD,.'
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