900430.pdfUSE PERMIT 0�
-- CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB � SUITE/APT#
OWNER NAME/NAME OF BUSINESS ADDRESS /�� % A00 CST
IFGAL DESCRIPTION CHECKI SUBDIVISION NO. ILID NO.
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Legal Description of Property -
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NEW RESIDENTIAL
ADDIALTER El COMMERCIAL
REPAIR 1:1APT. BLDG.
76,
TELEPHONE NUMBER
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TELEPHONE NUMBER
e all easements
EXCAVATE, FILL
DEMOLISH OR GRADE
CARPORT
REMODEL F GARAGE
WOOD STOVE/ ❑ RETAINING WALL/
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TYPE OF USE, BUSINESS OR ACTIVITY) EXPL/
NUMBER OF STORIES 1UNITS
NUMBER OFDWELLING
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
11 RENEWAL
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING REQUIRED DEDICATION
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
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SEE ENGINEERING MEMO DATED
REMARKS ,{
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METER SIZE BUILDING SUPPLY SIZE IFIXTURE UNITS
REMARKS
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AREA
ENV,
REVIEW
ALLOWED
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COMPLETE
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VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
REMARKS
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NING REVIEW BY
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HEIGHT I LOT COVERAGE
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SPECIAL INSPECTOR � M OCCUPANCY
REQUIRED GROUP f��
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REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check NO. MECHANICAL
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
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
cn successors in interest, agrees to indemnify, defend and hold
W 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
° 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 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
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
ti0n Insurance. INSPECTION
SIGNATURE IOWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF
EDMONDS
CALL FOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3,
102.87
FEE
OCCUPANT
LOAD
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,
OFF/ IA 'S /GNAT E DAT
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ELEASED B DATE
ORIGINAL — File YELLOW — Insp
PINK — Owner GOLD — Ass
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1 RECORD OF INSPECTIONS
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INSPECTOR DATE APPROVED \
SETBACKS
FOUNDATION'Ni: '
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Footing .. ........ - . .. , ,
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Pier/Porch ............. {,
. Retaining Wall
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PLUMBING:
Underground ..........
Rough -In ......... _
CF....................
HEATING:
Gas Test.......
Gas Piping ............ .
Equipment:........:..
CF............
FRAMING ...............
SHEETROCK NAILING .. .
\ SPECIAL INSPECTION
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FINAL APPROVAL
FOR OCCUPANCY .......
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