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CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
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OWNER NAME+NAME Of BUSINESS ADDRESS �{� /n " /. ,CJf i / 1
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LICENSE NUMBER EXPIRATION DATE
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Description of Property - Include all easements
Tar Account
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Parcel No. /,3
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NEW
L_J" RESIDENTIAL
PLUMBING
ElADDITION
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COMMERCIAL
MECHANICAL
APT. BLDG. +
El
REMODEL
SIGN
GRADING
PENCE
Q
REPAIR
CYDS.
(x—Fl
EjDEMOLISH
WOODSINSERT TOVE
HO TUB SPA
—r�ETAINING WALL/
❑GARAGE
CARPORT
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�i ROCKERY
❑ RENEWAL
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER OF STORIES
NUMBER OF
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DWELLING
Q
UNITS
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DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
LEGAL DESCRIPTION CHECK
SUBDIVISION NO. LID
NO,
PUBLIC RIGHT gF WAY PER OFFICIAL STREET MAP, TESCP
EXISTING —� REQUIRED DEDICATION ' RSPermit
StreettreetUne
PROPOSED �� In`npeetlge
Sidewalk
Appmed ❑
Required ❑
f?ormit Req'tl ❑
RogVifetl
Required ❑
REMARKS
ENGINEERING MEMO
9ATE ASVIEWBV '
METER SIZE
BUILDING SUPPLY SIZE
NO. OF FIXTURES -
REMARKS
SIGN AREA
ALLOWED PROPOSE�Exp
$EPA REVIEW
COM{/' TE �.- EXEMPT
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AD! PO, .
iL
S)H/ON LINE t
VARIANCE OR CU
P 7114REVIEW BY
SETBAC FEET 'jp�! J�/
FRONT SIDE f' REAR'
HEIGHT
LOT COVERAGE .
REMARKS
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CHECKED BY
TYPE OF CONSTRUCTION , -, CODE
OCKER 9, /
HEIGHT
SPECIAL INSPECTOR JAREA
REOUIRED
❑ YES
OCCUPANCY
GROUP
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OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED ,,
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
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HEAT SOURCE: GLAZING
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PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADNGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
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Permit Limit:1 Year - Provided Work Is StarteJ Within 180 Days
"Applicant, on behalf of his Or her spouse, heirs, assigns and
ENO. INSPECTION FEE
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successors in interest, agrees to Indemnify, defend and hold
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harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
iwhatever
nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
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modify, waive or reduce any requirement of any city ordinance
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nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
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provision."
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I hereby acknowledge that I have read this application; that the
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
slate laws regulating construction; and in doing the work authoriz•
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed In violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
wOAK NOTED
Deputy; and fees are paid, and receipt is
lion Insurance.
INSPECTION
acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
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CITY OF
OFFICI S N DA E
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EDMONDS
CALL FOR ,
LEASE P DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
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CHAPTER 3.
PINK — Owner GOLD — Assessor
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RECORD OF INSPECTIONSi
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INSPECTOR DATE APPROVED
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SETBACKS............
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FOUNDATION:
H.
Footing ................
ry
Wall ...................
5
Pier/Porch .............
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Retaining Wall..........
PLUMBING:
Underground ...........
Rough -In ..............
OF...............
HEATING:
Gas Test .............:.
Gas Piping .............?
Equipment .............
OF....................
s
FRAMING ..........
4�
SHEETROCK NAILING ..., `
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SPECIAL INSPECTION ..:
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FINAL APPROVAL r I ' •- -
FOR OCCUPANCY .......
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