890764.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER
NAME/NAME OF BUSINESS
�j���WNE^
OL.Y
'Y
k t ►L ,s
U191010:6111
�of� fls
E LICENSE NUMBER
coon of rroperty - inc
or attach two copies)
NEW I JIM RESIDENTIAL
AO ALTE COMMERCIAL
ElREPAIR APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
Q^ CARPORT
REMODEL I 'GARAGE
'j n
aWOOD STOVE/ RETAINING WALL/
INSERT ROCKERY
NUMBER OF
OF WORK
F!N
NUMBER
all easements
NUMBER OF
DWELLING
PLUMBING
(� MECHANICAL
LJ SIGN
FENCE
( x _FT)
1—1 SWIM
PLAN)
Av4d
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.
ZONE
PERMIT
NUMBER
joB
ADDRESS o? j yIC W o�L
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
TESCP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
EXISTING _.. REQUIRED DEDICATION
PROPOSED. -
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
N successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuance
= of this permit. Issuance of this permit shall not be deemed to
o modify, waive or reduce any requirement of any city ordinance
i nor limit in any way the City's ability to enforce any ordinance
provision."
1 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-
IE (OWNER(R AGENT) DATE SIGNED
ATTENTION
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED.
SEE ENGINEERING MEMO DATED
REMARKS
METER SIZE BUILDING SUPPLY SIZE (FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLETE ( EXEMPT
VARIANCE OR CU
SETBACKS -FEET
FRONT SIDE
Yil
REQUIRED
EI YES C' NO
Gl: ".:l
REVIEW BY
DATE
HEIGHT I LOT COVERAGE
OCCUPANCY OCCu
GROUP � 2 LOAD
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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
23�
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.
DATE
ORIGINAL — File YELLOW — I
PINK — Owner GOLD — Assess)6r
p.:^'.-.r�.,.�w..p..r.,..��Ha•-•.-�, v,....L.�r `....-..... r...+•�.,'.�.-, �..t�•�n�.: ,,^f r_.Ir
s
i
p
ri
'
♦
�(!,l il'x.:►• !,;•, y r, '4 >, ;ice
,�f.�,,.,;•. ECORD OF INSPECTIONS
Date Passed
rOUNDATION
House
Porches, piers
Retaining walls _
Garage, carport _
PLUMBING
Undergyround
Rough•in Y
Water service
HEATING SYSTEM
FRAMING q
WALLBOARD
FINAL
gV 70 1/,00000