840341.pdfw
- CITY OF EDMONDS
ZUSE ONE I PERMIT
_ Z NUMBER 341
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i CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
LEGAL DESCRI TION CHECK SUBDIVI'10
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TELEPHONE NUMBER
PUBLIC RIGHT/j�V F WAY PER OFFICIAL STREET MAP,
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
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SIGN AREA
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ALLOWED
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REPAIR RETAINING WALL
EXCAVATE PENCE
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CHECKED BY
TYPE OF CONSTRUCTION
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CODE
HEIGHT
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25 Mai
❑PRF.MOVE INSP.I SWIM
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SPECIAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
COMPLIANCE INSP. POOL
REQUIRED
GROUP �/ �2
LOAD
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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VALUATION
FEE
PLAW C:AEGK FEE
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This Permit covers work to be done on private property ONLY,
GRAOINGIFILL
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
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successors in interest, agrees to indemnify, defend and hold
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w harmless the City of Edmonds, Washington, its officials,
s employees, and agents from any and all claims for damages of
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iwhatever nature, arising directly or indirectly from the issuance
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of this permit. Issuance of this permit shall not be deemed to
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modify, waive or reduce any requirement of any city ordinance
i nor limit in any way the City's ability to enforce any ordinance
AMOUNT DUE^.
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provision:'
TOTAL
I hereby acknowledge that I 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
This application is not a permit until
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s tate laws regulating construction; and In doing the work authoriz.
AUTHORIZES
signed by the Building Official or his
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ed thereby, no person will be employed In violation of the Labor
Code of the State of Washington relating to Workmen's Compensa.
ONLY THE
WORK NOTED
Deputy; and fees are paid, and receipt is
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tion Insurance. A
INSPECTION
acknowledged In space provided.
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DEPARTMENT
CITY OF
OFFICIAL'S SIGNATURE
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11,1ATESIGNED
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EDMONDS
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ATTEN ON
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DATE /
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR MAY a �a ORIGINAL —File Y LOW —Inspector
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A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
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CHAPTER 3.
PINK — Owner GOLD — Assessor
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