910874.pdf-`
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB'S
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11�LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
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FrRIGHT OF WAY CONSTRUCTION PERMIT REQUIRED.
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CITY TELEPHONE NUMBER
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REMARKS
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5� L l I SIGN AREA ENV. REVIEW ADB NO.
Legal Description of Property - include all ease ents ALLOWED PROPOSED COMPLETE EXEMPT
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NEW IDENTIAL PLUMBING
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APT. SLOG,
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CARPORT SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REMODEL GARAGE POOL
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REQUIRYESED GROUP LOAD
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ROCKERY RENEWAL REMARKS
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PROGRESS INSPECTIONS PER UBC 305 m
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO BE DO (ATTACH PLOT PLAN)
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PLUMBING
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This Permit covers work to be done on private property ONLY. GRADNGIFILL
Any construction on the public domain (curbs, sidewalks,
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driveways, marquees, etc.) will require separate permission. STATE SURCHARGE.',;
Permit Application: 180 Days
ENERGY CODE
Permit Limit: 1 Year- Provided WorK is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
iwhatever
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
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modify, waive or reduce any requirement of any city ordinance
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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
Information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
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
This application is not a permit until
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ed thereby, no person will be employed In violation of the Labor
ONLY THE
signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tionlnsurance.
INSPECTION
edins ace provided.
acknowled g p p
TUBE (OWNER O GENT
DATE SIG ED
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DEPARTMENT
AFF,rievH 111NAT-1- n TF
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(iY CITY OF
t1� �lf�� .� "t EDMONDS
ATTENTI N 771-3202
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.
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-LEASED BY: DATI,
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ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
WALLBOARD _
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