930519.pdfCITY OF EDMONDS ZONE PERMIT
CONSTRUCTION PERMIT APPLICATION NUMBER
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STATE LICENSE NUMBER
Legal Description of
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ISION NO ILID NO
EU�% PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
EXISTING REQUIRED DEDICATION RW Permit Required
0 Street Use Permit Req'd ❑
PROPOSED Inspection Required
Sidewalk Required ❑ O
REMARKS i
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ENGINEERING MEMO DA p REVIEW BY
METER SIZE / JBVJILDING SUPPLY SIZE NO. OF FIXTURES
TELEPHONE NUMBER
SIGN AREA SEPA REVIEW
all easements ALLOWED PROPOSED COMPLETEr
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Tax Account Parcel No.
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REPAIR APT. BLDG.
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(TYPE OF USE. B�SINESS��\ZTIVITY) EXPLAIN:
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NUMBER OF STORIES NUMBER OF
DWELLING
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C..�'Y a UNITS 0I
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN
ElPLUMBING
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SETBACKS - FEET't vY HEIGHT
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SPECIAL INSPECTOR AREA OCCUPANCY Wf
REQUIRED GROUP ..-
YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
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PLAN CHECK FEE
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PLUMBING
Plan Check No.
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. 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
In successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
semployees, and agents from any and all claims for damages of�/!? CC1��6[G%�i4
whatever nature, arising directly or indirectly from the issuance
M 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
o 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
HEIGHT
OCCUPANT
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on given Is correct; and that i am the owner, or the duly ATTENTION APPLICATION APPROVAL
d agent of the owner. I agree to comply with city and
regulating construction; and in doing the work authoriz• THIS PERMIT This application is not a permit until
AUTHORIZES Pp
ety, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
he State of Washington relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
nce. INSPECTION acknowledged in space provided.O DATE SIGNED DEPARTMENT
OFF AL'S SIGNATURE
CITY OF DATE
EDMONDS
ATTENTION CALL FOR ELEASED DATE t
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE INSPECTION !'
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UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771=3202
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC %) ORIGINAL — File YELLOW —Inspector f`
CHAPTER 3.
102.87 ! l �� PINK — Owner GOLD — Assessor r