850047.pdfF'A.DDFIESS
CITY OF EDM=APPLICATION
CONSTRUCTION PERMIT NAME (OR NAME OF BUSINESS) ,
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ift I CITY LICENSE NL
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PERMIT
NUMBER
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CK SUDDIVISION NO. LID NO
.55V,S,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, '1
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EXISTING _....._ REQUIRED DEDICATI PROPOSED F WAV CONSTRUCTION PERMIT REQUIRED:.; USEPERMIT REQUIRED:GINEERING MEMO DATED DEPT. REVIEW CHECK LIST DATED_SIZE BUILDINPLY SIZE FIXTURE UNITS
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SIGN AREA ENV. REVIEW ADS NO,
ALLOWED I PROPOSED COMPLETE EXEMPT
VARIANCE OR CU
YARDS
FRONT
❑
if
NEW L—I RESIDENTIAL
I PLUMBING
❑ ❑
❑
ADDIALTER NOWRESIDENTIAL
MECHANICAL
❑ REPAIR ❑ RETAINING WALL
❑SIGN
EXCAVATE
❑ ❑
FENCE
❑
CHECKED BY TY
DEMOLISH OR FILL
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❑
PECTOR
SPECINSPECTOR
❑ COMPLOIANCESNSP.
POOL
REQUIREDSWIM
❑ ❑ WATER LINE
❑
YESAL
O YES NO
REMARKS
SIDE SEWER
P YLr C7 YLE
❑ ❑
❑
NUMBER OF STORIES NUMBER OF
UWtLLINU
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
-
PLAN CHECK FEE
BUILDING
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
Sul,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
or reduce any requirement of any city ordinance
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limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
prvision."
I hereby acknowledge that I have read this application; that the
ATTENTION
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
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
ad thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance.
INSPECTION
SIGNAT OWNER OR AGENT) GATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
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7713202
ATTENMON
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102 7a -
SHORELINE p
PLANNING REVIEW BY DATE
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LOT COVERAGE �
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)NSTRUCTION CODE HEIGHT
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EA OCCUPANCY OCCUPANT
GROUP f� �2 LOAD
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VALUATION FEE
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APPLICATION APPROVAL k'
This application is not a permit until I
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged In space provided. 1
OFFICIA 'S SIGNATURE.!`
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DATE
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ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD - Assessor
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RECORD OF INSPECTIONS
Date Passed"
FOUNDATION
House
Porches, Piers
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Retaining walls ----- --�
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Garage, carport ;>
PLUMBING
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Underground
Rough -in
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Water service
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HEATING SYSTEM
FRAMING
WALLBOARD
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