930846 (2).pdfi
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
MAILING ADDRESS
(�. t.Ji F 14)
CITY ZIP TELEPHONE NUMBER
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ADDRESS
CITY
NAME
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ADDRESS
ZIP ITELEPHONE NUMBER
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CITY ZIP TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
Ad4LrU5its /92
Legal Description of Property - include all easements
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Property
Tax Account L
Parcel No.
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
FGARAGE
CARPORT
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I -I RESIDENTIAL
COMMERCIAL
APT.BLDG.
'LL�� 1PLLUUMBING
lJ MECHANICAL
LJ SIGN
GRADING FENCE
CYDS. El I. x_FT)
WOODSTOVE SWIM POOL
INSERT HOT TUB/SPA
aRETAINING WALL/ ❑
ROCKERY RENEWAL
-qSS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES I UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
uae PERMIT �`j �1,19 ,�'
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ADDRESS / Y7 9 f % /SLY/�/�I C vIejAl10k a
LEGAL DESCRIPTION CHECKI SUBDIVISION NO TLID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING _ REQUIRED DEDICATION
PROPOSED
LINE SIZE
ERING MEMO DATED
NO, OF FIXTURES
TESCP Approved
❑
RW Permit Required
❑
Street Use Permit Req'd
❑
Inspection Required
❑
Sidewalk Required
❑
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PRV REQUIRED
a
YES ❑ NO ❑
3
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REVIEWED BY
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SIGN AREA
SEPA REVIEW
AOB NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
SHORELINE a
EXP
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS - FEET
HEIGHT
LOT COVERAGE
Z
2
FRONT SIDE REAR
Z
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REMARKS
CHECKED BY TYPE OF CONSTRUCTION COOS OCCUPANT
GROUP
SPECIAL INSPECTOR AREA r/ OCCUPANT
REQUIRED LOAD
❑ YES
_ a
PROGRESS INSPECTIONS PER UBC 305 s
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FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE: GLAZING
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
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
W harmless the City of Edmonds, Washington, its officials,
5 employees, and agents from any and all claims for damages of
< whatever nature, arising directly or indirectly from the issuance
= 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
° 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
ticln Insurance and RCW 18.27. r INSPECTION
SI N TURE IOWNER OR AGEN I.DATE SIGNED DEPARTMENT
TY OF
I DMO DS
,l���l-
CALL FOR
ATTENTION INSPECTION
T
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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.
OFF I L'S SIGN TUBE a DAT 9.
�Wsl
DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUC URE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 a 0220 ORIGINAL — File YELLOW — I pector U
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — sessor
102.87
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