920098.pdfUSE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION Jog
OWNER NAME/NAME OF BUSINESS ADDRESS
w MAILING ADDRESS
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CITY ZIP TELEPHONE NUMBE
NAME
ZIP (TELEPHONE NUMBER
NAME
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CITY t ZIP TELEPHONE NUMBER
STATE LICENSE NUMBER
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Legal Description of Property - include all easements
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PERMIT
NUMBER
SUBDIVISION
51240D98
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REOUIRED DEDICATION
PROPOSED
REMARKS
ENGINEERING MEMO DATED
METER SIZE
REMARKS
BUILDING SUPPLY SIZE
I
TESCP Approved ❑ 10
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑ Z
NO. OF FI
SIGN AREA SEPA REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE
EXP
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS -FEET HEIGHT LOT COVERAGE
FRONT SIDE REAR
Tax Account Parcel No.
NEW R1 RESIDENTIAL P UMBING
ADDIALTER COMMERCIAL MECHANICAL
REPAIR APT. BLDG. t�J SIGN
GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
�MlDEMOLISH CYDs. ( x_FT)��
CARPORT SWIM
REMODEL GARAGE POOL,
❑ WOOD STOVE/ ❑ RETAINING WALL/
INSERT ROCKERY RENEWAL
TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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SPECIAL INSPECTOR I AREA I OCCUPANCYI OCCUPANT I
REQUIRED
❑ YES
REMARKS
PROGRESS INSPECTIONS PER.UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
c3�✓ s�l�� 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
Penult 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,
M employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
0 of this permit. Issuance of this permit shall not be deemed to
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 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- AUTHORIZES
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
tion Insurance. INSPECTION
SIGNATURE lOWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF EDMONDS
CALL FOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE %%1-:.2OZ
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, USC
CHAPTER 3.
102.07
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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.
OFFCA S SF NATURE DATE
RELEASED BY: DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
to