850454.pdfUSE PERMIT
CITY OF EDMONDS ZONE UMBEn
CONSTRUCTION. PERMIT APPLICATION 5-17�
JOB
1 ADDRESS
NAME (OR NAM OF BUSINESS)
LEGAL DESC IPTION CHECK SUBDI SIO'
ZMAILING ADDRESS
NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING.......__......... REOUIRED DEDICATION.....- .. _.. ..
PROPOSED .. ..........
RIGHT OF WAY CONSTRUCTION PERMIT REOUIRED :
STREET USE PERMIT REQUIRED .
SEE ENGINEERING MEMO DATED. .. _.. ..___...
NUMBER SEE PIW DEPT. REVIEW CHECK LIST DATED.
0
SIGN AREA ENV. REVIEW
all easements
ALLOWED I PROPOSED COMPLETE I EXEMPT
.NEW
LJ RESIDENTIAL
❑ PLUMBING
,El
LJ ADDIALTER
❑ NONRESIDENTIAL
El MECHANICAL
❑ REPAIR
❑ RETAINING WALL
❑ SIGN
❑ DEMOLISH
❑ ORCFIILLTE
❑ (ENCE K_Ft)
ElPRE•MOVE INSPJ
❑ SWIM
COMPLIANCE INSP.
POOL
❑ SIDE SEWER
❑ WATER LINE
❑
❑
❑
❑
NUMBER OF STORIES
NUMBER OF
UWtLLINU
NATURE OF WORK TO BE DONE (ATTACH
Unus
PLOT PLAN)
JARIANC OR `UIPLANNING REVIEW 13Y AI.J
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FRONT SII E/ k7 REAR 6
RKS
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
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SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REOUIREO GROUP R4 LOAD
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REMARKS
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PLAN CHECK FEE
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BUILDING
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PLUMBING
/
MECHANICAL
This Permit covers work to be done on private properly 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
ENERGY CODE FEE
1.50
"Applicant, on behalf of his or her spouse, heirs, assigns and
v, successors in interest, agrees to indemnity, defend and hold
w harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
5 whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
0
ii modify waive or reduce any requirement of any city ordinance
x 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
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
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.
SIGN E OWNE OR ENT) SIGNED
DEPARTMENT
JDATE
8
CITY OF
OFFICIAL'S SIGNATUR
EDMONDS
ATTENTION
AUK .85
DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — Fil YELLOW — Inspector
A CERTIFCATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. , J�a,I �j PINK — Owner GOLD — Assessor
IO2-76
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