850616.pdfUSE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB
'I NAME IO AME OF BUSINESS) ADDRESS
�/) e / ///� LEGAL DEMAIL)NI ADDRESS
-- PERMIT 850616
NUMBER �,
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TELEPHONE NUMBER /[.I..T
IC RIGHT OF WAY PER OFFICIAL STREET MAP.
ING_— REQUIRED DEDICATION _
OSED __
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OF WAY CONSTRUCTION PERMIT REO r D r,
ET USE PERMIT REQUIRED 1�
ENGINEERING MEMO DA
SIZE
FATE LICENSE NUMBER
SIGN AREA ENV. REVIEW
ADS NO.
egal Description of Property •Include all easements
ALLOWED PROPOSED COMPLETE EXEMPT
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SHOR EN
VARIANCE OR CU PLANNING REVIEW BY
DATE
YARDS HEIGHT LOT COVERAGE
FRONT SIDE RE
REMARKS
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NEW RESIDENTIAL
PLUMBING
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ADDIALTER COMMERCIAL
MECHANICAL
REPAIR 1:1RETAINING WALL
SIGN
EXCAVATE
DEMOLISH OR FILL
FENCE
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CHECKED BY TYPE OF ^ NSTRUCTION CODE
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PRE -MOVE INSPl
El
SWIM
SPECIAL INSPECTOR AREA OCCUPANCY
OCCUPANT
REMODEL1:1 COMPLIANCE INSP.
POOL
RE UIRED GROUP
LOAD
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ElAPT.
RENEWAL
YES NO �3
REMARKS
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CUMBER OF STORIES NUMBEROF
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PLAN CHECK FEE
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
"Applicant, on behalf of his or her spouse, heirs, assigns and
N successors In Interest, agrees to Indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
s employees, and agents from any and all claims for damages of
a whatever nature, arising directly or Indirectly from the Issuance
0 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
provision:"
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
ti nlnsurance,
SIGNATURE (OWNER OR AGENT} DATE SIGNED
Gar A �ll�lc all- I-
THIS PERMIT This application Is not a permit until
AUTHORIZES signed by the Building Official or his
ONLY THE 9
WORK NOTED Deputy; and fees are paid, and receipt is
INSPECTION acknowledged in space provided.
❑EPARTMENT
CITY OF OFFICIAL'S U E DATE
EDMONDS p
ATTENTION
», 3202 R AGED BY:
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
102.78
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RECORD OF INSPECTIONS
Date Passed
rI[dAL . T
APPROVAL GIVEN BY:
FOUNDATION
n
Iitials Date
!lease
Porches, piers
_
Retaining walls
Garage, carport
Pirmain i.. (Ar-B)
I
PLUMBING
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Eng.neerinb
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Underground
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Rough -in
Water service
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HEATING SYSTEM
FRAMING
WALLBOARD
FINAL