850173.pdfUSE � PERMIT
CITY OF EDMONDS ZONuCNUMBER 80l7,
} CONSTRUCTION PERMIT APPLICATION JOB
NAME (O$NAME OF BUSINESS) ADDRESS
L/�/`~/I LEGAL DESCRIPTION CHECK SUBDIVISION HOL+ LIUV1IO. �/• `-'
ZMAILING ADDRESS
CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING - _._.. _. REQUIRED DEDICATION
PROPOSED-__ _... _..
NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED'
STREET USE PERMIT REQUIRED .
w ADDRESS
i SEE EIJGINEEFlING MEMO GATED ... . -- --- - ---- ----
�,r� i TELEPHONE NUMBER SEE. PIW DEPT. REVIEW CHECK LIST DATED.__. ---.--- ------
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CITYLICENSE NUMBEH
/ SIGN AREA ENV, REVIEW ADB NO.
all easements ALLOWED I PROPOSED COMPLETE I EXEMPT
RHDRELINE p
[YARDS
ARIANCE OR CU PLANNING REVIEW BY DATE
LOT COVERAGE
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FRONT SIDE REAR g
NEW ILA RESIDENTIAL
LdIENCE
ADDIALTER
NON-RESIDENTIAL
REPAIR
RETAINING WALL EXCAVATE
OR FILL
L❑PRE•MOVE
x§REOUIRED
PEDEMOLISH
INSP.1
SIDE SEWER
COMPLIANCE INS,
WATER LINE
NUMBER OF STORIES
NUMBER OF
DWELLING
UNI15
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
I /_ ' ::_ s n i i' s / A"v IT' 1
PLAID CHECK FEE
BUILDING
PLUMBING
MECHANICAL
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.
GRADINGIFILL
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
successors in Interest, agrees to tndemnify, 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
modify, waive or reduce any requirement of any city ordinance
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
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
WORK NOTED
Code of the State of Washington relating to Workmen's Compensa•
lion Insurance.
SI (OWNER OR AGENT(
INSPECTION
DEPARTMENT
�TIIE
TY OF
.�,ATE
DIMONDS
771.3202
ATTENTION
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.
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ORIGINAL — Fife YELLOW — Inspector U _ 1
PINK — Owner GOLD — Assessor
OCCUPANCY OL'CUPANT
GROUP LOAD
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.
FICIAL'S SIGNATURE . 4,
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RECORD OF INSPECT{ONS
Date Passed
FOUNDATION
House
Porches. piers
Retaining walls
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Garage, carport
PLUMBING
Underground
Rough -in
Water service
HEATING SYSTEM
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FRAMING
WALLBOARD
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