920089.pdf1USE
ZONE PERMIT
CITY OF
CONSTRUCTION . APPLICATI
JI MAILING ADDHE55
L /` IP6r,�" PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
CITY ZIP TELEPHON NUMBER// EXISTING REQUIRED DEDICATION
' _ `� PROPOSED
NAME
REMARKS
ZIP ITELEPHONE NUMBER
NAME
ENGINEERING MEMO
ADDRESS
METER SIZE BUILDING SUPPLY
CITY
STATE LICENSE NUMBER
of Property - i
Tax Account Parcel
TELEPHONE NUMBER
9.20089
LID NO
TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑
REVIEW BY
NO. OF FIXTURES
SIGN AREA SEPA REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE N
EXP
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS —FEET HEIGHT LOT COVERAGE
FRONT SIDE REAR
REMARKS
CJ NEW RESIDENTIAL PLUMBING
ADD/ALTER COMMERCIAL MECHANICAL
Lj REPAIR Lj APT. BLDG. LJ SIGN
DEMOLISH GRADING FENCE
El CVOS. ( X—FT)
CARPORT swim
REMODEL GARAGE POOL.
❑ WOO SETRT ROCKE YG WALL/ El RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES NUMBERDWELLINF
UNITS
e all easements
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
:NECKED BY TYPE OF �� INSTRUCTION CODE HEIGHT
SPECIAL INSPECTOR AREA OCCUPANCYA OCCUPANT
REQUIRED GROUP LOAD
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
e. U BUILDING
P , f" PLUMBING
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
successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
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
omodify, 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- AOUTHORIZENLYES
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
tion Insurance. INSPECTION
SIG RE ( WNER OR AGENT) DATE SIGNED DEPARTMENT
OF
o2 CITY
EDMONDS
CALL FOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771'3202
UNTIL CERTIFICATE INSPECTION
E EN ADE N OCCUPANCY HAS BEENGRANTED APPROVAL OR
D, ED, UBC
CHAPTER 3.
102.87
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFIC SIGNATU DAY
/o �-
-. �.xt, / DATE
ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor
s
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