890272.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN�,@'A= NAME/NAME SjNfj BUS 0 ^tlil
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RESIDENTIAL
ADDIALTER 11 COMMERCIAL
REPAIR APT.BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
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WOOD STOVE( ❑ RETAINING WALL/
INSERT ROCKERY
NUMBER
PLUMBING
1:1n MECHANICAL
LJ SIGN
aFENCE
( x _FT)
n SWIM
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
u&T„oc nc wnRK TO BE DONE (ATTACH PLOT PLAN)
RENEWAL
USE PERMIT
ZONE i NUMBER
JOB
ADDRESS ? �� VL'!P/L Ilee�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING __ REQUIRED DEDICATION ---
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED.
STREET USE PERMIT REQUIRED
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.vd 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."
d hi li ation• that the
SEE ENGINEERING MEMO DATED
METER SIZE BUILDING SUPPLY SIZE (FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW ADS NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE
VARIANCE OR CU PLAN N REVIE BY DATE
-4� t
SETBACKS -FEET ^04
HEIG LOT COVERAGE
FRONT GS SIDE IC' REAR2r �5I /
To 5' or. ICx -rev, 69k)
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By I7 TYPE of c ^ I 1?rs�
arM.01AL marcu,vn
REQUIRED GROUP
❑ YES C: NO S,SO
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have rea t s app c ATTENTION
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. 1 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
ti rance. INSPECTION
SI AT E (OWNER O T DLATESIGNED DEPARTMENT
CITY OF
EDMONDS
ATT NTION 771=32�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 0
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102•87
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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.
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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'RECORD OF INSPECTIONS
Date Passed " f
MUNDATION
House
Porches, piers
detaining walls'
Garage, carport
PLUMBING
Underground
moughoin
Water service
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL
43�102�2 ✓
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