860381.pdfS`
USE c. PERMIT r
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION job
NAME (OR NAME OF BUSINESS) y� ADDRESS /��y�W npt ve.
cJ l A4 S - I M RA UN LEGAL DESCRIPTION CHECKQSUB�DIIVVISION NO. / LID NO.
Z MAILING ADDRESS
G, o
CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
7 /OOD EXISTING REQUIRED DEDICATION
NAME PROPOSED
77c8—S57 31
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
ADDRESS STREET USE PERMIT REQUIRED ❑
c=i SEE ENGINEERING MEMO DATED
CITY TELEPHONE NUMBER
NAME
ADDRESS
NUMBER
TELEPHONE NUMBER
• Include all easements
NEW RESIDENTIAL 1:1PLUMBING
ADDIALTER COMMERCIAL F1 MECHANICAL
REPAIR CI AINING WALL SIGN
EXCA E FENCE
DEMOLISH O FILL (x_FT)
PRE-MOVE
INSPJ
swim
REMODEL COMPLIANCE INSP. POOL
❑WOOD STOVE/
INSERTAPT. BLDG RENEWAL
NUMBER OF STORIES NUMBER OF
I DWELLING
UNITS
NATURE, OF WORK TO BE DONE (ATTACH 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.
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
successors in interest, agrees to indemnify, 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,.walve or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
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
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-
REMARKS
SIGN
ALLOWED
VARIANCE OR CU
YARDS
SUPPL
PROPOSED
SIDE
ENV, REVIEW
COMPLETE I EXEMPT
REAR
CHECKED BY TYPE OF CONSTR
SPECIAL INSPECTOR AREA
REQUIRED
❑ YES ❑ NO
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PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATESURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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.
102.78
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771-320200
NING REVIEW BY
DATE
HEIGHT I LOT COVERAGE
DUDE HEIGHT
/ 7(T
OCCUPANCY OCCUPANT
GROUP LOAD
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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 i DA
BY:
ORIGINAL — File YELLOW —/ Instector
PINK — Owner GOLD — Assessor
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to RECOh OF INSPECTIONS
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FOUNDATION
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House
FINAL' APPROVAL GIVEN BYt Porches, piers
3 ct
g WaIIS
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Retainin �titi ;�`',. \�ti�<
Initials Date
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Garage,'carport
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Buildingto
PLUMBING ,
Fire Dept. ,:',`r, s . :_ t III .. 3 ..
Underground '
Planning (ADD),,. \ { ' r I, ,�,; . X r
I. Rough in <,, ,\t, t"� ,
Engineering
Water service
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HEATING SYSTEM
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FRAMING
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WALLBOARD
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