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USE ZONE �G74
ITY OF EDMONDS
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NUMBIER
CQNS U TION PERMIT APPLICATION
ADDRESS /. ,,SUITE/APTx
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LEGAL DESCRIPTION CHECK SUBDIVISION NO. D NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. Approved ❑
CITY ZIP TELEPHONE NUMBER
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RIM Pe
RIMPermitUse Required ❑
EXISTING REQUIRED DEDICATION $!reel Use Permit Req'tl ❑
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Inspection Requirod ❑
NAME
PROPOSED Sidewalk Required ❑ 0
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REMARKS
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C CITY ZIP TELEPHONE NUMBER
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ENGINEERING MEMO DATED REVIEW BY
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ADDRESS
of 1917 /5.an�
METER SIZE BUILDING SUPPLY SIZE NO.OFFIXTURES
CITY ZIP TELEPH�O/NE NUMBER
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REMARKS 3
O STATE LICENSE NUMBER
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SIGN AREA SERA REVIEW ADB NO.
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ALLOWED PROPOSEDTEX
Legal Description of Property all easemenjj$
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VARIANCE OR CU PLANNING REVIEW 0Y DATE
SETBACKS - FEET HEIGHT LOT COVERAGE ?
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FRONT SIDE REAR Z
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REMARKS
NEW RESIDENTIAL PLUMBING
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ADDIALTER COMMERCIAL IG��=�jj MECHANICAL.
ElREPAIR APT, BLDG. SIGN
GRADING FENCE
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CHECKED BY TYPE OF CONST UG710N CODE HEIGHT
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DEMOLISH CYDS, I_x_Fn
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CAR
REMODEL GARAGET swim
SPECIAL SPEG13YTOR AREA OOCADPANT
POOL
REQUIRED GROUPANCV
❑ES
❑WOOD STOVE/ ❑ RETAINING WALL/ ❑
RENEWAL
REMARKS
INSERT ROCKERY
PROGRESS INSPECTIONS PER UBC .305 o
(TYPE OFU E, Oy INESS OR ACTIVITY)EXPLAIN:
m
O NUMBER OF -STORIES NUMBER OF
wo DWELLING
m UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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FINAL INSPECTION REQUIRED
VALUATION FEEnow
;
PLAN CHECK FEE .i
BUILDING
PLUMBING
Plan Check NO.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGWILL
Any construction on the public domain (curbs, sidewalks,
;
driveways, marquees, etc.) will require separate permission.
STATESURCHARGE
- Permit Application: 180 Days
Permit Limit: 1 Year- Provided Work is Started Within 180 Days
STORM DRAINAGE FEE
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` "Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
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w harmless the City of Edmonds, Washington, its officials,
5 employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
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of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
,.;.
0 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 DUES'.)
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
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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
Building Official his/her
ad thereby, no person will be employed in violation of the Labor
ONLY THE signed by the or
Code of the State of Washington relating to Workmen's Compensa-
WORK Norso Deputy; and tees are paid, and receipt is
tlon Insurance.
SIGNATURE OR AGEN 1� SATE SIGNED
INSPECTION acknowledged in space provided.
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DEPARTMENT
(OWNER
/ /} �-' CITY OF OFFICI 'B SIGNATURE, DATE
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EDMONDS C�
CALL FOR RELEASED BY: DATE
TENT ON
INSPECTION
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 i
CHAPTER 3.
10207
PINK - Owner GOLD - Assessor
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_RECORD OF INSPECTIONS,"',
DATE APPROVED
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fINSPECTOR
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SETBACKS'
FOUNDATION
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Footing................
.................
i Wall...,... ..
Pier/Porch .............
Retaining Wall..........
PLUMBING:
Underground ..........
Rough -in ..............
CF.....................
HEATING:
Gas Test ...............
___.. Gas Piping ............ "
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Equipment .............
CF....................
FRAMING ...............
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INSULATION ............
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SHEETROCK NAILING...
SPECIAL INSPECTION ... -
FINAL APPROVAL" p f
i FOR OCCUPANCY.....
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