880809.pdfCITY OF EDMONDS
CONSTRUCTION
.• PERMIT
. APPLICATION
NAME •- NAME OF
USE PERMIT
ZONE NUMBER
JOB
ADDRESS / Sr / Q I
I.FGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
Z
o I D TESCP
CITY TELEPHONE MBTEMARKS
GHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
—_ REOUIREDDEDICATIOND ___-___
NAME
WAY CONSTRUCTION PERMIT REQUIRED.SE PERMIT REQUIREDw ADDRESS
REVIE
= INEERING MEMO DATED
U TELEPHONE NUMBa CITY
NAME
j U v METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
i TY TELEPHONE NUMBER
z q1dKaez� yysy REMARKS
0
STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - Include all easements
(show below or attach four copies) SHORELINE N
Z
0
a VARIANCE OR CU PLANNING REVIEW BY DATE
FE
Uj
W
o YARDS HEIGHT LOT COVERAGE
J
w FRONT SIDE REAR
-j REMARKS
NEW RESIDENTIAL PLUMBING
ElADDIALTER COMMERCIAL MECHANICAL
REPAIR CI RETAINING WALL LJ SIGN
EXCAVATE FENCE CHECKED BY TYPE OF CONSTRUCTION CODEHEIGHT
DEMOLISH El OR FILL I. x—FT) fc� 1. ! / C�// 5
El❑ PRE -MOVE INSP.1 ElSWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REMODEL COMPLIANCE INSP. POOL REQUIRED GROUP LOAD
WOOD STOVE( ❑ OYES NO
❑
INSERT APT.BLDG RENEWAL REMARKS
PROGRESS INSPECTIONS PER UBC 305
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
PLAN CHECK FEE
BUILDING
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 World 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
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
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i 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
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 pl rson 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 AGENT) DATE SI NED DEPARTMENT
I I�r N k� 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.
102.87
VALUATION
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.
OFFIC SIGNATU DATE
yJ7
ELEASED BY( DATE
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ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor
A