880262.pdfUSE PERMIT
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NAME (OR NAME OF BUSINEADDRESS j o
LEGAL DESCRIP ON H K SUBDIVISION NO/.' LID NO.
MAILING ADDRESS'�.�TESCP
CITYPUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
�, EXISTING REQUIRED DEDICATION
v (/� PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED. .
STREET USE PERMIT REQUIRED
REVIEW BY
SEE ENGINEERING MEMO DATED
TELEPHONE N
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TELEPHONE NUMBER
LICENSE NUMBER
Opp
Description of Property - Include all easements
below or attach four copies)
I� NEW CI RESIDENTIAL LJ PLUMBING
ADDIALTER COMMERCIAL �n MECHANICAL
C� REPAIR CI RETAINING WALL El SIGN
EXCAVATE
DEMOLISH OR FILL� (EN Fy x3�F�1
❑❑ PRE -MOVE INSP.I ElSWIM
REMODEL CM OPLCE IANIN POOL
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SERT F APT. BLDG El RENEWAL
REMARKS
ILDING SUPPLY SIZE
FIXTURE UNITS
SIGN
AREA
ENV.
REVIEW
ALLOWED
I PROPOSED
I
COMPLETE
I EXEMPT
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VARIANCE OR CU PLANNING REVIEW BY DATE
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YARDS / _ / HEIGHT LOT COVERAGE Z
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FRONT/ SIDE /✓n REARJ� 6ks Z Z
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CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
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SPECIALINSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP —3 LOAD
1❑ YES C NO
REMARKS
PROGRESS INSPECTIONS PER USC 305
NUMBER OF STORIES NUMBER OF
� DWELLING
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) ,S I ��� ✓
VALUATION FEE
PLAN CHECK FEE
BUILDING too
FFS N PLUMBING
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 -
W 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 PLAN CHECK DEPOSIT
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 TOTAL AMOUNT DUE
provision.'
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
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 This application is not a permit until
state laws regulating construction; and In doing the work authoriz- AOUTHORIZES signed by the Building Official or his
ed thereby, no person will be employed in violation of the Labor
NLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
acknowledged in space provided.
tion Insurance. INSPECTION
SIGNATURE.(pWN R OR AGENT) DATE SIGNED DEPARTMENT OF I AL'S SIGNATU�3E TE
00
CITY OF
EDMONDS
771 _3202 ELE ED Y DATE
ATTENTION G r � 20
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ORIGINAL —File YELLOW —Inspector
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC PINK — Owner GOLD — Assessor
CHAPTER 3. r
102.87
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FOUNDATION
House
Porches, piers
Retaining walls
Garage, carport
PLUMBING
Underground
Rough•in
Water service
HEATING SYSTEM
FRAMING
WALLBOARD:
FINAL