860787.pdfI
1.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
irl
NAME
ADDRESS
CITY
STATE LICENSE NI
Legal Descripti
(show below or
NUMBER
TELEPHONE NUMBER
Include all easements
NEW RESIDENTIAL PLUMBING
ADDIALTER COMMERCIAL MECHANICAL
REPAIR RETAINING WALL
EXCAVATE
DEMOLISH OR FILL
PRE -MOVE INSPJ
REMODEL COMPLIANCE INS
WOOD STOVE/ ❑
INSERT APT. BLDG
SIGN
❑FENCE
(_ x _FT)
RENEWAL
j NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
103
USE PERMIT
ZONE �� ^ 1 NUMBER 860
JOB l (�
ADDRESS / q2 � I)/V��/G
LEGAL DESCRIPTION CHECKI SUBDIVISION NO. ILID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
METER SIZE (BUILDING SUPPLY SIZE (FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE i EXEMPT
VARIANCE OR CU
YARDS
FRONT SIDE
CHECKED BY ITYPE
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
REAR
REVIEW BY I DATE
HEIGHT I LOT COVERAGE
4ez
OCCUPANCYOCCUPANT
GROUP LOAD
'L 770/ S l� s
N I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
oN
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application:180 Days
ENERGY CODE
Permit Limit: 1 Year, Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
u) successors in interest, agrees to Indemnify, defend and hold
J harmless the City of Edmonds, Washington, Its officials,
Q 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
PLAN CHECK DEPOSIT
0
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
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz•
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa•
WORK NOTED
ti n Insurance.
INSPECT(
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF
EDMONDS
ATTENTION 771 3202
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
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.
FF AL'S SIGNATURE DA
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SED BY: � I DATE
Lie
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ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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FOUNDATi �Q Lo'��
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Porches, pies " r
Retaining; walls_
Garage, carport —