890419.pdfI •.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT
NUMBER
JOB
ADDRESS
_EGAL DESCRIPTION CHECK SUBDIVISION'NO. LID NO
1,
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.
SEE ENGINEERING MEMO DATED
ADDRESS 1 r _
f -7 TIREMARKS
Y TELEPHONE NUM
TE lICENULegal Descriptionof Property - include all easements
(show below or attach two copies)
NEW kF RESIDENTIAL
ADDIALTER El COMMERCIAL
El REPAIR APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
❑ WOOD STOVE/ RETAINING WALL/
INSERT ROCKERY
NUMBER OF STORIES
OF WORK TO
DWELLING
UNITS
I
t' V PLUMBING
n� MECHANICAL
`J SIGN
FENCE
I. x _FT)
M SWIM
RENEWAL
VARIANCE OR CU
NG SUPPLY SIZE
PROPOSED
SETBACKS - FEET
FRONT SIDE
ECKED BY I TYPE OF
ENV. REVIEW I ADB NO.
COMPLETE i EXEMPT
REAR
NG REVIEW BY DATE
HEIGHT I LOT COVERAGE
600
SPECIAL RE UIREDYES INSPECTOR
NO (AREA OCCUPIGROUPANCjp` OCCU� I LOAD
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING I I /S"
PLUMBING
0
A. ' MECHANICAL
This Pbrmit 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 Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
in successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
0 of this permit, Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
i 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
state laws regulating construction; and in doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
ti n Insurance. INSPECTION acknowledged in space provided,
SIGNATURE (OWNER OR AGENT) D /E SIGNED DEPARTMENT
?� /r CITY OF OFFI L'S SIGNATURE qAT�
EDMONDS /
ATT E N N 771 _3202 REL E DATE `
IT IS UNLA FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE `
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL ile YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC Z
,
CHAPTER 3. PINK — Owner GOLD — Assessor
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RECORD OF INSPECTIONS 1.
Date Passed
FOUNDATION
.House
Porches, piers
Retaining wails
Garace, carport
PLUMBING
• Under,Yrnund'
Rougirin
water service
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL,
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