890361.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O 1RtLER NAME/NAME QF BUS bJESS
CITY
below or attach two
NEW
SO
i
TELEPHONE NUMBER
- include all easements
RESIDENTIAL
ADDIALTER COMMERCIAL
REPAIR APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
QWOOD STOVE RETAINING WALL/
INSERT ROCKERY
NUMBER OF STORIES
NATURE OF WORK TC
Z ect S�W
NUMBER C
DWELLING
UNITS
M
PLUMBING
MECHANICAL
ZONE
JOB
ADDRESS
PERMIT
NUMBER
DIVI
bl
APROPOSED.--
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING__.__ REQUIRED DEDICATION
L. J SIGN
FENCE
X _FT)
n SWIM
RENEWAL
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 person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
ti Insurance.
51 N TURE O�i OR A�iEf�1T4of
���,� D SII / � /P9
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
ALLOWED / PROPOSED
OR CU
— FEET
SIDE
BY ITYPE OF
SPECIAL INSPECTOR
REQUIRED
Cl YES L: NO
C v
UD NO,
TESCP
APPROVED BY
ENV. REVIEW I ADS NO.
COMPLETE EXEMPT
REAR
REVIEW BY I DATE
HEIGHT ILOT COVERAGE
GROUP
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING
PLUMBING C20
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
ATTENTION
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
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771-3202
OCCUPANT
LOAD
1-7Vv
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.
CIFNCIAL'S SIGNAT RE DATE
53I�i 1
RELEASED BY: DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
Ix
W
i
3
-..—,„�..� . T.a.....,v—.n. ..
. �l,n ''•' eve , -
A:.i d'r -�._ _ __, r �-"'.'+nY`'7S.'<.•s.�Hf.7;..Y�at.-•rfayaJ t"':`yi:. � t r � � �%T�-
d•Fi[ !'�'LT'' ;"^� � a'i ��.fe` r is � �' r r •ter -`
r\
9
RECORD OF INSPECTIONS
Date Passed
FOUNDATION
House ---
Porches, piers
Retaining walls
Garage, carport
PLUMBING
Underground
Rough•in /O
Water servic
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL