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CITY OF EDMONDS ZONE PERMIT
CONSTRUCTION PERMIT APPLICATION JOB NUMBER
OWNER NAME-NdE OF BrESS ADDRESS
J1l C' 11 G Q 1LEGAL DESCRIPTION CHECKI SUSDIVISKIN NO
NAME
NAME
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AD RESS Q�
CITY
,A ( AfioL��rl-�Ei )P- I
Leoal DescriDtion of Prooert
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Tax Account]
Parcel No. I
TELEPHONE NUMBER
TELEPHONE NU
- include all ease
f f
BLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ISTING REQUIRED DEDICATIONOPOSED
MARKS
EXPIRATION DATE
Il;
PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL APT. BLDG.El SIGN
1:1 FoolGRADING FENCE
REPAIR CYDS. ( x_FT)
Fool DEMOLISH SWIM POOL INSERTTOVE HO TUB SPA
GARAGE ❑ RETAINING WALL/ (�
CARPORT ROCKERY L I RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES NUMBER OF
I DWELLING
I UNITS
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DESCRIBE WORK TO Bf DONE (ATTACH PLOT PLAN)
9 3029t
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TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
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Sidewalk Required ❑ I t9
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ENGINEERING MEMO DATED
REVIEW BY
METER SIZE BUILDING SUPPLY SIZE NO. -OF FIXTURES
REMARKS
SIGN AREA
SEPA REVIEW
ADB NO.
ALLOWED I PROPOSED
COMPLETE IEXEMPT
I I SHORELINE H
EXP
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS —FEET HEIGHT LOT COVERAGE Z
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FRONT SIDE REAR Z
REMARKS g
a.
CHECKED BY TYPE OF ONSTRUCTION CODE HEIGHT
" -r1�I���ed— 1 /
SPECIAL INSPECTOR AREA JOCCUPANCY„_ OCCUPANT
ID
GROUP �J LOAD
YES
PROGRESS INSPECTIONS PER UBC 305 to
m
FINAL INSPECTION REQUIRED
VALUATION
f�� PLAN CHECK FEE
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HEAT SOURCE: 4 .J GLAZING BUILDING
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
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
N successors in interest, agrees to indemnify, defend and hold
J harmless the City of Edmonds, Washington, its officials, /1 s,
employees, and agents from any and all claims for damages Of J I J< h
a whatever nature, arising directly or indirectly from the issuance
= of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
o 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
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
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 to Iating to Workmen's Compensa- WORK NOTED
ti I n Insurance. INSPECTION
ATM(OWNER ' OR G T) DATE SIGNED DEPARTMENT
CITY OF
EDMONDS
ATTENTION ` I CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UDC
CHAPTER 3.
102.87
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.
OFFICI S TURF DATE
RELEASED BY: DATE
ORIGINAL
— File
YELLOW
— Ins
PINK —
Owner
GOLD —
Assey
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