830659.pdfFI+ 4%
CITY OF EDMONDS
CONSTRUCTION PERMIT_ APPLICATION
(OR NAME OF BUSWES
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CITY TELEPHONE NUMBER
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1-1STATELICENSE NUMBER ICITY LICENSE NUMBER
1 Leeal Description of Properly - Include all easements
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PERMIT
_a/.�//' •') NUMBER
RESS /,OZ i ),/
rP*UBLITC RIGHT OF WAY PER OFFICIAL STREET MAP.
NG REQUIRED DEDICATION
SED_ _
OF WAY CONSTRUCTION PERMIT REQUIRED I
T USE PERMIT REQUIRED fI
NGINEERING MEMO DATEDW DEPT. REVIEW CHECK LIST DATEDKS Q,pFpl,
LiNEW
I0-RESIDENTIAL
u PLUMBING
❑ ADDIALTER
❑ NON RESIDENTIAL
❑ MECHANICAL
❑ REPAIR
❑ RETAINING WALL
❑ SIGN
❑ DEMOLISH
❑ OR FILLTE
❑ ;_.—FT)
INSP./
❑ SWIM
❑PRE•MOVE
COMPLIANCE INSP.
POOL
❑ SIDE SEWER ❑ WATER LINE
❑
NUMBER OF STORIES
NUMBEROF
DWELLING
METER SIZE IBUILDING SUPPLY S1ZE IFIXTURE UNITS
ALLOWED I PROPOSED I COMPLETE I EXEMPT
VARIANCE OR CU IPLANNING REVIEW BY I DATE
YARDS LOT COVERAGE
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SPECIAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
REQUIRED
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REMARKS
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BUILDING
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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
m successors in Interest, agrees to Indemnify, defend and hold
w harmless the Cityof Edmonds, Washington, its officials,
s 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
r nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
Provision."
'—
I hereby acknowledge that 1 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
stale laws regulating construction; and In doing the work authoriz- AUTHORIZES
This application Is not a permit until
ed thereby, no person will be employed In violation of the Labor ONLY THE
signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
Deputy; and fees are paid, and receipt is
Insurance. INSPECTION
acknowledged In space provided.
SI URE WNER R A E DATE SI N _ DEPARTMENT
CITY OF
EDMONDS
OFFICIAL'S SIGNATURE
JAoA.,/.,,
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THIS SITE IS LOCATED IN THE CITY
- I rt ,
OF EDMONDS. LOCAL SALES TAX 775.2525
ATTENTION SHOULD BE CODED 31,04.
DATE 2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL INSPECTIONHAS BE MADEAPPROVALOR ORIGINAL — File YELLOW — Inspector
BC .EC, 9 1g83
G ED U
ACERTIFICATE HAS BEENAN
CHAPTER 3.
10278
PINK —Owner GOLD —Assessor
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RECORD OF INSPECTIONS
Date Passed
FOUNDATION'
House
Porches, piers''
.; Retaining walls''
Garage, carp ort
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PLUMBING
Underground.
I
Rough in
Water service
HEATING 41 TE.
—3 "84 1�2`
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FRAMING:;
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3,
FINAL
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