930185.pdf!DE
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
1 !1 SCRIPTION CHECK SUBDIVISION O.
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CITY i ( /\l ZIP ITELEPHO NUMBER REQUIRED DEDICATION
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NAME
S
W ADDRESS
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U
a CITY ZIP TELEPHONE NUMBER
NAME
STATE LICENSE NUMBER
NOL'tiLk
Legal Description of Pro
Property
Tax Account L
Parcel No.
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
I I CARPORT
(TYPE OF USE, B
NUMBER
EXPIRATION DATE
. include all easeme
RESIDENTIAL
COMMERCIAL
APT. BLDG.
❑ GRADING
CYDS.
WOODSTOVE
INSERT
❑RETAINING WALL/
ROCKERY
ESS OR ACTIVITY) EXPLAIN:
wNUMBER OF STORIES NUMBER OF
o DWELLING
m 1 UNITS
pJSCRIR WORK TO BE DONE (ATTACH PLOT PLAN)
Kn.(0a t nf[ q L 6 / k414
LJ PLUMBING
11 MECHANICAL
n
LJ SIGN
FENCE
( x_FT)
SWIM POOL
HOT TUB/SPA
RENEWAL
S op
ENGINEERING MEMO DATED
METER SIZE (BUILDING SUPPL'
REMARKS
TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑
NO. OF FI
SIGN
AREA
SEPA
REVIEW
ALLOWED
I PROPOSED
COMPLETE
(EXEMPT
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
ED BY
EXP I
PLANNING REVIEW BY
REAR
a
REVIEW BY
rURES
w
3
AD8 NO.
7
SHORELINE N
DATE
HEIGHT I LOT COVERAGE
SPECIAL INSPECTOR AHEA UUUUVANL;T
REQUIRED GROUP
❑ YES
r
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
HEAT SOURCE: GLAZING
o/D PLUMBING
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATESURCHARGE
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, .
Qemployees, 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.'
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
tl n Insurance. INSPECTION
SI N TURE (OWNER OR AGE II, DATE SIGNED DEPARTMENT
1 n C CITY OF
-K EDMONDS
CALL FOR
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
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3.
102•B7
OCCUPANT
LOAD
°O y�
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.
OFFICIA SI TUR�DATE
RELEASED BY. DATE
ORIGINAL — File YELLOW — Inspector
If
PINK — Owner GOLD — Assessov/
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