930518.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP ITELEPHONE
NAME
ADDRESS
CITY ZIP TELEPHONE NUMBER
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STATE LICENSE NUMBER EXPIRAT C
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Legal Description of Property - include all easements
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ZONE PERMIT �10516
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ADDRESS
.EGAL DESCRIPTION CHECK SUBDIVISION NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING REQUIRED DEDICATION
PROPOSED
REMARKS
ENGINEERING MEMO DATED
E/APT a
NO
TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required O 10
METER SIZE BUILDING SUPPLY SIZE NO.OF
REMARKS
DATE
SIGN AREA SEPA REVIEW
ALLOWED I PROPOSED COMPLETE (EXEMPT
I I EXP I
VARIANCE OR CU PLANNING REVIEW BY
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REVIEW BY
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ADB NO.
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DATE
SETBACKS = FEET HEIGHT LOT COVERAGE z
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Property FRONT SIDE REAR =
Tax Account S I I �� 1, i�- T REMARKS 5
Parcel No. `Y J
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL APT. BLDG. LJ SIGN
GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION COD HEIGHT
C� REPAIR CYDS. I. x_FT) /�FI/n�'/f�i
WOODSTOVE SWIM POOL
DEMOLISH ❑ INSERT SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
HOT TUB/SPA REQUIRED GROUP LOAD
GARAGE RETAINING WALL/ ❑ YES
CARPORT El ROCKERY RENEWAL REMARKS
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TYPE OF USE. BUSINESS R ACTIVITY�EXPLAIN: r PROGRESS INSPECTIONS PER UBC 305 s
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NUMBER NUMBER OF CRITICAL
OF DWELLING I AREAS
STORIES '' UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOTPLAN)
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HEAT SOURCE: GLAZING
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Plan Check No.
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days .
"Applicant, on behalf of his or her spouse, heirs, assigns and
r) successors in interest, agrees to indemnify, defend and hold
y harmless the City of Edmonds, Washington, its officials,
e employees, and agents from any and all claims for damages of
i whatever nature, arising directly or indirectly from the issuance
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
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
91IN
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3,
102.87
FINAL INSPECTION REQUIRED
- VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
STORM DRAINAGE FEE
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
CALL FOR
INSPECTION
771-0220
FEE
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 ' +&If3VRE DATE
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RELEASED BY: DATE
ORIGINAL — File YELLOW — I
PINK — Owner GOLD — P
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