900872.pdfFCITY OF EDMONDS
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RUCTION PERMIT APPLICATION
E/NAM OF,BYSINESS
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NAME
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CITY ZIP TELEPHONE NUI
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NAME
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Legal
Description
atol tach two copies)
all easemer
Tax Account Parcel No.
L-1 NEW LRESIDENTIAL
ADDIALTERMERCIAL
,BLDG,
CI REPAIR
EXCAVATE, FILL
El DEMOLISH OR GRADE
CARPORT .
REMODEL GARAGE
❑WOOD STOVE/ r7 RETAINING WALL/
INSERT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPL/
NUMBER OF
NATURE OF WORK TO
,en(17" *
NUMBER OF
DWELLING
UNITS
ICI
ZONE
ADDRESS
PERMIT
NUMBER
/0
TESCP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
EXISTING REQUIRED DEDICATION
PROPOSED
L_I PLUMBING
1:1 MECHANICAL
ElSIGN
❑FENCE
( x._FT)
t-1 SWIM
PLAN)
107
RENEWAL
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
METER SIZE BUILDING SUPPLY S12E FIXTURE UN
REMARKS
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLETE I EXEMPT
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
I.71
TYPE
REAR
NING REVIEW BY
0
NO.
DATE
HEIGHT I LOT COVERAGE
SPECIAL INSPECTOR I AHLA '
REQUIRED GROUP
❑ YES G NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
Plan Check No,
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
m 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
zwhatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
of this permit. Issuance of this permit shall not be deemed to
9 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
tiQn Insurance. I'lDATE SIGNED DEPARTMENT
SIGNATURE IOWNEF OR AGENJI /�l
0
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,
102.87
CITY OF
EDMONDS
CALL FOR
INSPECTION
771=3202
OCCUPANT
LOAD
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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.
NgE:
DATE
IGINAL Ile YELLOW — Inspector
PINK —Owner GOLD — Assesso j
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SETBACKS.
r._ FOUNDATION: C, r
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Footing •
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Wall .
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Pier/Porch .. ... • ..
Retaining Wali...... ..Li
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PLUMBINGrL
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Rough -In ..
tCF .................... I ,
HEATING:
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Gas Test........ .
fGas Piping .
Equipment . .. ; _ j
CF. ..........
FRAMING . • . • • .
SHEETROCK NAILING • . .
SPECIAL INSPECTION
FINAL APPROVAL 1.
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FOR OCCUPANCY ...... .
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