900899.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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NAME
ADDRESS
CITY
NAME
ZIP (TELEPHONE NUMBER
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ADDRESS
CITY ZIP TELEPHONE NUM
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STATE LICENSE NUMBER
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Description of Property - Include all easements
below or attach two copies)
Tax Account Parcel No.
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING REQUIRED DEDICATION
IPROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
T6R
SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
SSIGN AREA ENV. REVIEW
WED I PROPOSED COMPLETE I EXEMPT
ElNEW 5 RESIDENTIAL 11 PLUMBING
KADDIALTER El COMMERCIAL 93 MECHANICAL
EJREPAIR APT. BLDG. SIGN
FILL PENCE
DEMOLISH OR GRADE x—FT)
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REMODEL F1 GARAGET El POOL
❑ WOO INSERT
WALLS
❑ ROCKERY RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES NUMBER OF /
/ DWELLING
UNITS
NATURE OF WORK E (ATTACH PLOT PLAN)
Bn>dv�tAC� �o
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
BY ITYPE OF
REAR
REVIEW BY
ADB NO.
DATE
HEIGHT I LOT COVERAGE
SPECIAL INSPECTOR I AncA vvuuvmll .I
REQUIRED GROUP
❑ YES I NO
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
v, 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
iwhatever 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
IZ ES
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washingt n relating to Workmen's Compensa- WORK NOTED
tion Insurance. INSPECTION
(O�WKER OR A DATE SIGNED c� DEPARTMENT
TY OF
DIMO DS
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•B7
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( 'S SIGNATURE DATE
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oe, enecn nv DATE
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ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assesso'r>
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OUNDATION '
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FRAMING .. • • .
SHEETROCK NAILING
SPECIAL INSPECTION
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FINAL APPROVAL ,i
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