860223.pdfCITY OF EDMUNDS
CONSTRUCTION PERMIT APPLICATION
NAMES (OR NAME OF BUSINESS)
Y )
ADDRESS
,
CITY
STATE LICENSE NUMBER
V4//je5/V1
ZONE
JOB
ADDRESS
PERMIT
NUMBER
DUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING REQUIRED DEDICATION
PROPOSED
m
NU
SS 3 4 '�
- Include all easements
DNEW RESIDENTIAL
DADDIALTER D COMMERCIAL
DREPAIR D RETAINING WALL
EXCAVATE
D DEMOLISH OR FILL
n f-I PRE•MOVE INSPJ
DWOOD STOVEI D INSERT APT, BLDG
NUMBER OF
TURE OF
DWtLLING
UNI1b
PLAN)
PLUMBING
DMECHANICAL
DSIGN
DFENCE
(_ x _FT)
f-1 SWIM
DRENEWAL
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.
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
m successors in interest, agrees to indemnify, defend and hold
w 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
I hereby acknowledge that I have read this application; that the
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
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-
E (OWJJE``��OR AGENT) DATE SIGNED
ATTENTION
RIGHT OF WAY CONSTRUCTION F
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO
REMARKS
NI
TER SIZE (BUILDING SUPPLY SIZE (FIXTURE
MARKS
SIGN AREA ENV, REVIEW
ALLOWED I PROPOSED COMPLETE I EXEMPT
i
VARIANCE OR CU IPLANNING REVIE�VBY I DATE
YARDS
FRONT SIDE AR I HEIGHT (LOT COVERAGE
BY I TYPE OF CONSTRUCTION I CODE I HEIGHT
SPECIAL INSPECTOR AEl OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
❑ YES O
REMARKS
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sWoke
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PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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,
102.78
C.
WSM
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES ONLY THE signedy b the Building Official or his
WORK NOTED Deputy; and fees are paid, and receipt is
INSPECTION acknowledged in space provided.
DEPARTMENT
CITY OF OFFICIAL'WSIGVNA:TUF(f,� DATE
EDMONDS N
771.320
REL EG BY: DA E
r;
ORTGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor ,
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RECORD • OF INSPECTIONS
t Date Passed
FOUNDATION
.: , . House
' .T GIVEN BY: i
Porches, piers'
Iaitinls Date
Retaining walls • --
Garage, carport'
c PLUMBING
- a Rough -in
r 11
Water service:
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL 8Not
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