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CITY OF EDMONDS ZONE NUMBIER 92IUt� 3G
CONSTRUCTION PERMIT APPLICATION JOB IT APT0
OWNER N ME/NAME OF BUSI % S ADDRESS l// �J� jc�i IL011110J�
D LEGAL DESCRIPTION CH(IECCK SUBDIVISION NO. LIDNO
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O PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
CITY ZIP ELEPHONE N BER RW Permit Required ❑
EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑
Inspection
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PROPOSED Sidewalk Required d ❑ (9
NAME Z
1j REMARKS w
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CITY ZIP TELEPHONE NUMBER
NAME
t ENGINEERING MEMO DATED REVIEW BY
Cr ADDRESS
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Cr METER SIZE BUILDING SUPPLY SIZE NO. OF FIXTURES
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Z REMARKS 3
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O STATE LICENSE NUMBER IIIIIIIII
SIGN AREA SEPA REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE (EXEMPT
Legal Description of Property - include all easements SHORELINE a
VARIANCE OR CU
EXP I
PLANNING REVIEW BY
DATE
SETBACKS — FEET HEIGHT LOT COVERAGE
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FRONT SIDE REAR
J Tax Account Parcel No, REMARKS
NEW 54 RESIDENTIAL PLUMBING
ADDIALTER El COMMERCIAL UNO MECHANICAL
REPAIR APT. BLDG. El SIGN
GRADING ❑ C�~1j
FENCE CHECKED BY TYPE OF CONSTRUCTION CODE _ HEIGHT
DEMOLISH CYDS. ( X_FT)
REMODEL CARAGET a SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
POOL REQUIRED GROUP i2
1 LOAD
❑ YES
WOOD STOVE( ❑ RETAINING WALL/ ❑ INSERT ROCKERY RENEWAL REMARKS
0 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: P GRESS INSPECTIONS PER UBC 305
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w NUMB R OF STORIES rDELLING
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DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
C FINAL INSPECTION REQUIRED
UIO� it VALUATION FEE
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L PLAN CHECK FEE
' BUILDING S
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Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days STORM DRAINAGE FEE
Permit Limit: 1 Year- Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
cn 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
whatever nature, arising directly or Indirectly from the Issuance PLAN CHECK DEPOSIT
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance s3Z,
o 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 APPLICATION APPROVAL
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 This application is not a permit until
state laws regulating construction; and in doing the work authoriz AUTHORIZES signed by the Building Official or his/her
Ed thereby, no person will be employed in violation of the Labor ONLWONKY THE
EO Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa• acknowledged in space provided.
tion Insurance, INSPECTION
SIGNATU E (O ER OR AGENT( DATE SIGNED DEPARTMENT OFFICIAL'S SIG ATURE
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EDIMONDS
CALL FOR
RELEAS DATE
ATTENTION d 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 — Inspec
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3. PINK — Owner GOLD — Asses'sor
102.87
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