880302.pdfe
U USE PERMIT
CITY OF EDMONDS ONE NUMBER
CONSTRUCTION PERMIT APPLICATION joe
NAME (OR NAME OF BUSINESS) r•r ADDRESS /�0 q
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ADDRESS
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CITY
STATE LICENSE Nl
Legal Descript
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TELEPPH�'O�JNE�NUUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING --- REQUIRED DEDICATION—.
MM PROPOSED
C_ N RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
TELEPHONE NUMBER
REMARKS
TESCP
APPROVED BY
Zoe METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
TELEPHONE NUMBER w
21
REMARKS 3
E (yt(h�v
SIGN AREA ENV. REVIEW ADB NO.
)erty include all easements ALLOWED PROPOSED COMPLETE EXEMPT
Ur copies) I I SHORELINE A
VARIANCE OR CU
YARDS
FRONT
PLANNING REVIEW BY
SIDE REAR
DATE
HEIGHT I LOT COVERAGE
L7
z
z
z
5
a
H NEW RESIDENTIAL H PLUMBING
ADDIALTER COMMERCIAL 0 MECHANICAL
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REPAIR RETAINING WALL LJ SIGN
DEMOLISH � OR FILLTE ❑ PENCE 1. xFT) FREMARKS
TYPE CONSTRUCTION 1CODEf�5 HEIGHT
❑ PRE -MOVE INSP./ ❑ SWIM TOR AREA OCCUPANCY OCCUPANT
REMODEL COMPLIANCE INSP. POOL GROUP 17 03 LOAD
1-i YES
❑ WOODINSERT ❑ APT. BLDG RENEWAL l'NO
t,o INSPECTIONS PER UBC 305 0
rL 5
m
NUMBER OF STORIES NUMBER OF
I DWELLING
I 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, 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 pbrson will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
tion Insurance.
SIGNATURE (O ER OR AGEN ' DATE SIGNED
J
PLAN CHECK FEE
MECHANICAL
I
ENERGY CODE
TNIN
PLAN CHECK DEPOSIT
A
TOTAL AMOUNT DUE
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
TTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771-3202
VALUATION
2 3 U�
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official )or his
Deputy; and fees are paid, and r ceipt is
acknowledged in space provide
OFFICIAL'S SIGNATURE DATE
ox
RELEA ED BY: DATE
;/-
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor