890798.pdfi
` CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME O BUSINESS
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MAILING ADDRESS
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CITY TELEPHONE NUMBE j J
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CITY
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ADDRESS
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ATE LICENSE NUMB V
%gal Description of Property - inc
how below or attach two copies)
U NEW .G+Bd RESIDENTIAL
Aff ADDIALTER C1 COMMERCIAL
REPAIR APT.BLDG.
a EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
WOOD STOVE/ RETAINING WALL/
INSERT ROCKERY
NUMBER OF
NATURE OF WORK TO
USE
ZONE
JOB
ADDRESS / Q'
PERMIT
NUMBER
:CK SUBDI
K
890798
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCPAPPROVED BY
EXISTING.--.. - REQUIRED DEDICATION --
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
NUMBER
R y3 REMARKS
all easements
LJ PLUMBING
(� MECHANICAL
L J SIGN
FENCE
( x _FT)
t—1 SWIM
NUMBER OF
DWELLING
UNITS
(ATTACH PLOT PLAN)
r Y /K/
/0x
RENEWAL
Ned gwsz
BUILDING SUPPLY SIZE
ALLOWED
AREA
a PROPOSED
ENV. REVIEW
COMPLETE I EXEMPT
VARIANCE OR CU IPL}Ifl"G REVIEW BY
SETBACKS - FEET HEIGHT LOT COVERAGE
FRONT /* oCj"IDE REAR
Me
arwv..-......... --' -- GROUP
REQUIRED
rl YES NO /20
MARKS
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
"2 % BUILDING
PLUMBING
MECHANICAL
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This Permit 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
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
whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
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 TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the ATTENTION
information given is correct; and that 1 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
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 n Insurance. INSPECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
' CITY OF
EDMONDS
ATTENTION 771-32
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
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VALUATION
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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 SIGNATURE DATE
ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor
1
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RECORD OF INSPECTIONS
Date Passed
EOUNDAT10.I4 fo�
House
porches, pierg
Retaininc walls -----
Gara;;e, carport---------
PLUNIBING
Under^rWnd ---• — .�— —�
ROLL 10n
water service ------
HEATING SY";1'cM--------- -�
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