880575.pdfUSE PERMIT
CITY OF EDMONDS�®
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CONSTRUCTION PERMIT APPLICATION
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CITY S� T EPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
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�1� RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED Il�
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REMARKS
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Legal Des iption of Property - include all easements OMP
(show below or attach four copies) SHORELINE#
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NEW EuY1RESIDENTIAL ,v � PLUMBINGEl
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REPAIR RETAINING WALL SIGN
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DEMOLISH OR FILLx—�
PRE -MOVE INSP.I SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REMODEL COMPLIANCE INSP. POOL EQUIRED GROUP F LOAD
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w NUMBER OF STORIES NUMBER OF �6Qt� %il'S/� On/S U&I SP-G 305 G 30( m
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NkkTURE OF WORK TO PE DQNE TTAC)i PLOT PLAN) —
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VALUATIOh FEE
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BUILDING
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MECHANICAL 29
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._ may}-c,iq by yvc l 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,
employees, and agents from any and all claims for damages of
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a whatever nature, arising directly or indirectly from the issuance
z 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
° 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- AUTHORIZES signed b the Building Official or his
ed thereby, no person will be employed in violation of the Labor ONLY THE 9 Y 9
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance. INSPECTION acknowledged in space provided.
SIGNAT RE WNER OR A(#NT) DATE SIGNED DEPARTMENT
CITY OF OFFICIAL'S SIGNATURE DATE
EDMONDS
771.3202 'RELEASED BY: D224
ATTENTION ( �,� /��zh z8
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE �
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspect
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A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
102-78