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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNFfAME/NAME OF BUSINESS
n
NAME
CITY
,
)escription of Property - include
below or attach two copies)
L_1 NEW JEM� RESIDENTIAL
ADDIALTER 1:1COMMERCIAL
REPAIR El APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
WOOD STOVE a RETAINING WALL/
INSERT ROCKERY
/A✓� 7* /4ZI0
NUMBER OF STORIES NUMBER OF
2 DWELLING
UNITS
OF WORK TO BE
CE
:PHONE NUMBER
3
easements
I. I PLUMBING
13 MECHANICAL
LJ SIGN
FENCE
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f-t 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. 1 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-
ER QoS AaFNT) IDATE SIGNED
ZONE
ADDRESS
oo W.: __.._.
8907463
PERMIT
NUMBER
1990 W C
IIPTION CHECKI SUBDI
and
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
TEH S/2, �IBUILDING , �PPLY SIZE IFIXTUR�UNITS cc
IL"
74Y 3
SIGN AREA ENV. REVIEW ADS NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT
VARIANCE O U NNI EVIEW BY DATE
N ,:ImAf
SETBACKS - FffT HEIGHT J LOT COVERAG
FRONT Z5 SIDE REAR 5 5 1
REMARKS
.6615 KWr6 00 8F4rr QL.AA)
(W I lV & 6iWSi5Me&rr Zoo
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
S
rEQUIRED
SPECTOR AREA OCCUPANCY OCCUPANT
GROUP /�'j LOAD
C NO
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING
PLUMBING
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,
1024,
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771=3201
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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.
OFFICIAL'S SIGNATU
DATE
ELE BY. DATE
�a��
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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RECORD OF INSPECTIONS
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