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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
NAME
CITY
STATE
or attach four
USE � PERMIT
ZONE NUMBER t300
JOB /
S_
ADDRESS � � Za � 7
o._ei ngA .RIPTInN C.WFr.K cuaDIVISION NO. LID NO.
�0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TELEPHONE NUMBER
2
2 EXISTING REQUIRED DEDICATION
PROPOSED
• Include all easements
i� NEW RESIDENTIAL
ADDIALTER COMMERCIAL
❑ REPAIR RETAINING WALL
EXCAVATE
DEMOLISH OR FILL
❑❑ PRE -MOVE INSPJ
REMODEL COMPLIANCE INSP.
WOOD STOVE/ ❑
INSERT APT, BLDG
NUMBER OF STORI
NATURE OF WORK
11 PLUMBING
MECHANICAL
SIGN
❑FENCE
( x _FT)
11 SWIM
DWELLING
UNITS
BE DONE (ATTACH PLOT PLAN)
RENEWAL
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
METER
REMARKS
SIGN AREA
ALLOWED I PROPOSED
VARIANCE OR CU
YARDS
FRONT SIDE
SIZE
ENV, REVIEW
COMPLETE I EXEMPT
REAR
NING REVIEW BY
UNITS
Q
w
3
ADB NO.
SHORELINE#
DATE
HEIGHT I LOT COVERAGE
[REJOUIRED
ECKED BY TYPE OF Corvslnu� I1w"
o- ri 16t82
PECIALINSPECTOR AREA OCCUPANCY OCCUPANT
GROUP n , LOAD
YES ❑ NO �" •7
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 anck
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, waive 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•
tion Insurance.
_.... �. .... .......i�o no kAdMTi AT DATE SIGNED
2 lwl-y 6
STALLA-norS d- VSE 10 CoN�o
i
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE
L
TION
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE TA/01 f 0
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 APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his
ONLY THE Deputy; and fees are aid, and receipt is
WORK NOTED P Yi P
acknowledged in space provided.
INSPECTION
DEPARTMENT DATE
OFFICIAL'S SIGNATURE
CITY OF GI,2/,= , SG
EDMONDS ja R-uNxa,
RELEASED BY: DATE/
771.3202 � i Cl •ter/
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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"CORD OFINSPECTIONS
,,, Date Passed
FOUNDATI0R '...,'
House
FINAL APPROVAL GIVEN BY:
Porches, p!�rs _
Initials Date Retaining walls .
Garage, carport
Building
PLUMBING
Fire Dept.
Underground
Planning (ADB)
Rough•in j
Engineering
Water service
r„
HEATING SYSTEM
FRAMING
WALLBOARD ;
' FINAL ,p�6 ��,1�• ..
uST�N6 �aoWD
t3vYzl�tNG
Sp�c.Tloty OF I KTo
I;R,a� STAND �N� pow hN�� V E3NT � � t •
BXcyY �K� Nt6TAtop GN/MNG7'm g
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