850050.pdfUSE PERMIT
CITY OF EDMONDS ZON!k< NUMBER
CONSTRUCTION PERMIT APPLICATION oe
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LEGAL DESCHII'IION C%_CK S`U}BDIVISION NO,
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CITY TELEPHONENUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
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PROPOSED __.. .
NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
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ADDRESS STREET USEPERMIT REQUIRED
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SEE ENGINEERING MEMO DATED
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CITY TELEPHONE NUMBER SEE PIW DEPT. REVIEW CHECK LIST DATED...
S C A TT L C k—A i &4 S t`� REMARKS
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NAME
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ADDRESS
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TELEPHONE NUMBER
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STATE LICENSE NUMBER CITY LICENSE NUMBER
t? v o r w S 3 SIGN AREA ENV REVIEW ADB I
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property -include all easements
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(show below or attach four copies) SHOREL
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Z " f A.) 4 4 r' tnJ rI YARDS �� � � .a r LOT CGO—VE�RA� I
FRONT SIDE REAR3J
LiNEW
LM RESIDENTIAL
IJ PLUMBING
® ADO/ALTER
❑ NON-RESIDENTIAL
❑ MECHANICAL
❑ REPAIR ❑ RETAINING WALL
❑ SIGN
EXCAVATE
FENCE
❑
PE OF COI
❑ DEMOLISH ❑ OR FILL
1_x_F
❑
❑ SWIM
ARE
COM PLOIANCESNS P.
POOL
rREQUIRED
❑ SIDE SEWER ❑ WATER LINE
DUMBER OF STORIES
NUMBER OF
DWtLUNG
UNI ICVATURE
OF WORK TO BE DONE IATTACH
PLOT PLAN)
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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.
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
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
v, successors in interest, agrees to indemnify, defend and hold
'a harmless the City of Edmonds, Washington, its officials,
5 employees, and agents from any and all claims for damages of
a 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
i 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
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
f Washington relating to Workmen's Compensa•
WORK NOTED
INSPECTION
(OWNERR AGU/EN T) SIGNED
DEPARTMENT
[7 JOATE
LL
EDMONDS
771.3202 ..d
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR •?r.'
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
UBC
CHAPTER 3.
102 18
[) ' OCCUPANCY OCCUSPANT
GROUP � 7 LOAD
VALUATION
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.
OFFICIAL'S SIGNATURE
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IGINAL — File YELLOW — Inspector Lj
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PINK — Owner GOLD — Assessor
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RECORD -OF -INSPECTIONS.
Date.Passed
FOUNDATION
House.
Porches, piers
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Retai0in. Walls
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FRAMING
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