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CITY OF EDMONDS ZONE NUMBER 9Zg6
CONSTRUCTION PERMIT APPLICATION dca
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CP Approved
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REQUIRED DEDICATION Street Use Permit Req'd
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Inspection Required
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REMARKS
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SIGN AREA SEPA REVIEW ADS NO.
Legal Description of Property - include all easements
ALLOWED .PROPOSED COMPLETE E%EMPT
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VARIANCE OR CU PLANNING REVIEW BY DATE
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NEW RESIDENTIAL PLUMBING
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APT. BLDG. L_J SIGN
REPAIR
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CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
DEMOLISH CYDS. l_I i—x_Fn
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CARPORT SWIM
REMODEL GARAGE
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
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REQUIRED GROUP LOAD
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WOOD STOVE/ RETAINING WALL/
INSERT ROCKERY RENEWAL
REMARKS
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PROGRESS INSPECTIONS PER UBC 305
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,BUSINESS OR ACTIVITY) EXPLAIN;
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NUMBER OF STORIES NUMBER OF
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A ' �/ %i// C.�� PLAN CHECK FEE
BUILDING
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Plan Check No. ! yt tT MECHANICAL
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This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sldewplks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
REQUIRED
VALUATION
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
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
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."
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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
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
This application is not a permit until
stale 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 ONLY THE
State Washington relating to Workmen's Compensa- WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the of
acknowledged in space provided.
i ion Insuran e.
SIGNATURE WNWNT)?
DATE SIGNEDj
INSPECTION
DEPARTMENT
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CITY OF
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EDMONOS
CALL F
RELEAEED B
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
1 320
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 77 ORIGINAL — File YELLOW — Inspector I y: "
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. URIC</�f'
CHAPTER 3. PINK — Owner GOLD — Assessor
102 BT
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