890919.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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TELEPHONE NUMBER
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ADDRESS
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CITY
STATE LICENSE NUMBER
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Legal Description of Property - inc
(show below or attach two copies)
E NUMBER
'ELEPHONE NUMBER
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easements
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IC�Y NEW )C% RESIDENTIAL
ADD/ALTER COMMERCIAL
REPAIR APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
WOOD STOVE/ ❑ RETAINING WALL/
INSERT ROCKERY
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LJ PLUMBING
n� MECHANICAL
LJ SIGN
FENCE
( x _FT)
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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Zhis 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
N successors in interest, agrees to indemnify, defend and hold
J harmless the City of Edmonds, Washington, its officials,
Q employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuance
0 of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
Ox nor limit in any way the City's ability to enforce any ordinance
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 tf}elState of Washington relating to Workmen's Compensa-
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ATTENTION"
USE PERMIT
ZONE ��/ Z NUMBER 89C*L9
JOB
ADDRESS 47_ 5 OL�rwnc.. V/5�vj i
LEGAL DESC IPTION CHECK SUBDIVISION NO. LID 1,40
vyy-3�7-�71 /P
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING - IRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED .
SEE ENGINEERING MEMO DATED /111312r4 f E
METER SI E BUILDINGS PLY SIZE IFIXTURE UNITS
LU
REMIT
/(/ 44�6;/
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
/ SHOREWWII
VARIANCE OR CU PLANNING REVIEW BY D�
SETBACKS - FEET ,•• HEIGHT LOT COVERAGE/
FRONT •'74 SIDE //li REAR Z 013
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CHECKED BY TYPE OF CONSTRU TION CODE HEIGHT
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SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP /V LOAD
fa YES C NO
PROGRESS INSPECTIONS PER UBC 305
;W"AVAL ram:«
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
VALUATION
FEE
�000
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ATTENTION APPLICATION APPROVAL
THIS PERMIT AUTHORIZES This application is not a permit until
ONLY THE signed by the Building Official or his
WORK NOTED Deputy; and fees are paid, and receipt is
INSPECTION acknowledged in space provided.
DEPARTMENT
CITY OF OFFICIAL'S SIGNATURE DATE
EDMONDS
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771 _3202ASED BY: DATE
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ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — ASS SS) �1
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Date Sent To Engineering
ENGINEERING APPROVAL FOR OCCUPANCY
MEMO TO: Permit Coordinator
Building Division
FROM: Lyle Chrisman
Engineering Inspector
DATE INSPECTE D: 12I1 a
SUBJECT ADDRESS:
PERMIT HOLDER:
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Q�e/L L PERMIT
PERMIT APPROVED FOR FINAL
iC PERMIT NOT APPROVED FOR FINAL, SEE REQUIREMENTS
Requirements:
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Additional Comments:
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RECORD OF INSPECTIONS
Date Passed• ;
EOUN DATION ,
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Porches, piers
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