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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ON CHECKI SUBDIVISION NO. LID
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING _ REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED Ci
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
REMARKS
7
ADB NO.
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1:1 1_J CNEW �lRRESIDENTIAL1:1 PLUMBING
1
L_I ADDIALTER LOMMERCIAL F MECHANICAL
REPAIR El RETAINING WALL LJ SIGN
EXCAVATE FENCE
rD�REMODEL
EMOLISH OR FILL ( x_FT)
PRE -MOVE COMPLIANCE
E IN ❑ SWIM
COMPLIANCE INSP. POOL
WOO
SERT ❑ APT. BLDG RENEWAL
NUMBER OF STORIES NUMBER OF
I DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
Fvp— 1265'F A� u�-� ram
METER SIZE (BUILDING SUPPLY SIZE (FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLETE I EXEMPT
s
YARDS HEIGHT LOT COVERAGE I
FRONT SIDE REAR
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CHECKED BY TYPE.QE CONSTRUCTION CODE HEIGHT
►4 1 (966
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP e �3 LOAD
❑ YES G' NO I
PROGRESS INSPECTIONS PER UBC 305
FIRE beP7 MEMO DATED II- 19 • S
VALUATION FEE
PLAN CHECK FEE .31
BUILDING Doc) j[Q
PLUMBING11CCJJ
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
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
N successors in interest, agrees to indemnify, defend and hold
J harmless the City of Edmonds, Washington, its officials,
i employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuance
x of this permit, Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
i 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 ATTENTION
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 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
tion Insurance. INSPECTION
SIGNATURE (OWNER OR A NT) SIGNED DEPARTMENT
o�c ors f 3 (�4` (ib CITY OF
JIDATE
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.
102.87
79
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.
O-F�FICIAL'S SIGNATURE DATE
o.�� I1�1 . �- 12.31-$
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Assessor
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RECORD OF INSPECTIONS {
Dati Passed 4.
FouNo,a-rlort
FINAL .APPROVAL GIVEN BY: House
Initials Date Porches, piers
Building R•:taining walls
Fire Dept. Garane, carport
Planaia (ADB) j PLIJ� 1+i31NG _ _
Engineering t)ndcr ground _
Rough•in
:dater service
HENVING SYSTEa1
FRAMING
WALLBOARD
FINAL N1
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