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USE PERMIT
NUMBER
CITY OF EDMONDS ZONE
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CONSTRUCTION
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
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METER SI�� BUILDING fUPPLY SIZE FI%TURF UNITS,I.
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999
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STATE LICENSE
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L' L= ALLOWED PROPOSED COMPLETE EXEMPT
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Legal Description of Property - include all easements
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(show below or attach two copies)
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REMARKS
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NEW RESIDENTIAL PLUMBING
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MECHANICAL
ADD(ALTER COMMERCIALS
APT. BLDG. E] SIGN CA C4 r��
REPAIR
TYPE CONSTRUCTION COD HEIGHT
FILL ❑ FENCE FT)
OR GRADE
DEMOLISH
CARPORT SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
O REMODEL GARAGE POOL OUIRED GROUP LOAD
❑ WOOD STOVE! a RETAINING WALL/ ❑ ES L: NO
INSERT ROCKERY RENEWAL REMARKS O
PROGRESS INSPECTIONS PER UBC 305 0
(TYPE OF USE, BUSINESS OR ACTIVITY) E%PLAIN:
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NUMBER OF STORIES NUMBER OFDWELLING�m�t.£IYSC(t
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UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) 5:;&&% �� � 1, r-��' 1'� ✓
C . `✓� NFINAL INSPECTION REQUIRED
VALUATION FEE
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PLAN CHECK FEE j 1�Z
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BUILDING j
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Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL l
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE ' }t
Permit Application: 180 Days
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Permit Limit: 1 Year- Provided Work is Started Within 180 Days ,fhiI
"Applicant, on behalf of his or her spouse, heirs, assigns and JMWFCVW PO4?-
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o successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials, p G1�J
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s employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuanceLy-
T of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance p
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE'$ E' '
provision."
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL'
information given is correct; and that I am the owner, or the duly F,
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
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state laws regulating construction; and in doing the work authoriz• AUTHORIZES
signed by the Building Official or his
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 Deputy; and fees are paid, and receipt is
tion Insurance. INSPECTIONacknowledged in space provided.
SI R (OWN R OR AGENT) JDATE SIGNED DEPARTMENT j
Q OFFICI L'S SIGNATURE / DA E
' O EDIMONO S
CALL FOR RELE ED DA E
ATTENTION INSPECTION / 71J 7 6
IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202
- UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A
CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER
3. PINK — Owner GOLD — Assessor)
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