920483.pdfCITY OF EDMONDS
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NSTRUCTION PERMIT APPLICATION
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G ADDREY ZIP TELEPHONE NUMBER
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NAME
ADDRESS
USE
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ADDRESS lZ/%
LEGAL DESCRIPTION CH
PERMIT�
NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REOUIRED DEDICATION
PROPOSED
REMARKS
CITY ZIP TELEPHONE NUMBER
NAME
ENGINEERING MEMO DATED
ADDRESS
METER SIZE BUILDIN(
CITY ZIP TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER EXPIRATION DATE
Legal Description of Property - dude all easemerytS� A `
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Property
Tax Account �`'� _
Parcel No. `L
NEW 1:1RESIDENTIAL El PLUMBING
ADDITION 0 COMMERCIAL El MECHANICAL
REMODEL APT. BLDG. El SIGN
GRADING
REPAIR 1:1CYDS. x (OFT)
SWIM POOL DEMOLISH NSERTTOVE HOTTUB SPA
FGARAGE RETAINING CARPORT 1:1ROCKERY WALL ❑ RENEWAL
> NUMBER OF STo (ES NUMBER OF
I n / DWELLING
1 UNITS _
)
' DESCRIBE W RK O BE DONE (ATTACH PLOT PLAN)
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TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑ c7
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REVIEW BY
NO. OF FIXTURES
SIGN AREA SEPA REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE q
EXP
VARIANCE OR CU i LA I G REVIEW BY DAT
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SETBACKS — FEET HEIGHT LOT C VERA E
FRONT SIDE REAR
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
ne�o ��
SPECIALINSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED _
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
17 PLAN CHECK FEE
BUILDING
HE SOURCE: GLAZING
% 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
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
of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
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 co ly with city and THIS PERMIT
state laws regulating construction; and in d g the work authoriz• AUTHORIZES
ed thereby, no person will VbeployedXviolation of the Labor ONLY THE
Code of the of Washielati o Workmen's C pen WORK NOTED
tl n Insur C INSPECTION
R1nNATLIRV1QCVNER OR AGEN , DATE SI9,VED DEPARTMENT
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U T1 - NN �I
IT NLA FUL TO USE OR OCCUPY BUILDI G OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3.
102•87
CITY OF
`ffMONDS
CALL FOR
INSPECTION
771=0220
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and r eipt is
acknowledged in space providg.
ORIGINAL — File YLLLOW - Inspec
PINK — Owner GOLD — Ass, Sor
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