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USE PERMIT
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CONSTRUCTIONICATION eoa
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NAME (OR NAME OF BUSINESSIADDRESS - I'We I
-�, LEGAL DESCRIPTION CHECK SUBDIV ION IO.LID NO.
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CITY•N`UMVBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.0
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NAME PROPOSED______ i
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED I I
STREET USE PERMIT REQUIRED I -
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CITY TELEPHONE NUMBER SEE PIW DEFT. REVIEW CHECK LIST DATED __.._ _------�--��
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ADDRESS
METER SIZE BUILDING PPLY SIZE FIXTURE UNITS
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TELEPHONE NUMBER
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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SI ENV. REVIEW ADS NO.
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ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property -Include all easements
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(show below or attach lour copies) SHORELINEN
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❑ PLUMBING
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❑ ADDIALTER ❑ NONRESIDENTIAL MECHANICAL
❑ REPAIR ❑ RETAINING WALL ❑ SIGN WOC_ "1�
CHECKED BY TYP OF CON$TRUtCTI `N' CODE HEIGHT
❑ FENCE
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❑PRE•MOVE INSP.I ❑ SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
COMPLIANCE INSP, POOL REQUIRED GROUP LOAD
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❑ SIDE SEWER ❑ WATER LINE ❑ REMARKS l7
❑ ❑ ❑ rs5 tr� m
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NUMBER OF STORIES NUMBEROF
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DWELLING
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UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
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VALUATION FEE
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PLAN CHECK FEE
BUILDING
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This Permit covers work to be done on private property ONLY. GRADINGIFILL
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Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
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Permit Application: 180 Days
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Permit Limit: 1 Year- Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and,
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successors in interest, agrees to Indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
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of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
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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
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
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 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
tion Insurance. INSPECTION acknowledged in space provided.
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GN TURE (OWNER OR AG NTI / DATE SIGfjEO CC DEPARTMENT
fir✓ J()-- p� OFF, IAU SIGNATURE
CITY OF
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'4 IS SITE IS LOCATED IN THE CITY EDMONDS L
OF EDMONDS. LOCAL SALES TAX AT
7752525
ATTENTION
SHOULD BE CODED 31.04.
3a 83
IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File Y LLOW — Inspector
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CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER
10278
3. PINK — Owner GOLD — Assessor
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( RECORD OF INSPECTIONS •;: ; ,
Date. Passed `
" FOUNDATION
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House
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R:!aining walls
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Garage, carport,
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_.. _. PLUMBING'
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_ Water service
HEATING SYSTEM -
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FRAMING
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FINAL
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