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CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION
ADDRESS
PERMIT 9110 /10
NUMBER �.J ICf Vl4
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING._._-_._-_._ nEOUIRED DEDICATION..__.__.....
PROPOSED
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TELEPHONE NUMBER
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LINE 517.E
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TELEPHONE NUMBER
NAME
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ENGINEERING MEMO DATED nEVIEWEfi BY
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TELEPHONE NUMB,
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FIRE MEMO DATED nEVIFW LD BY
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SIGN AREA
ALLOWED PROPOSED
BEPA REVIEW
COMPLETE JE%EMIT
ExP
ADP NO
Legal Description of Property - include all easement
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SHORELINE a
VARIANCE OR CU
PLANNING REVIEW BY
GATE
_
SETBACKS — FEET
FRONT SIpE REAR
HEIGHT
LOT COVERAGE
T- A—iRI Y / • f
Pnlccl No
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�.;. RESIDENTIAL PLUMBING
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.V COMMERCIAL MECHANICAL
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/❑Ill hlliPll APT. BLDG. l._J SIGN
CYOS.
❑ ?TI`\ n ❑GRADING ❑PENCE %—�
CHECKED By
TYPE OFcCO�RUCTION COOL
OgoU
WOODS
DL'.MUL1511 NSERT WOODSTOVE swim HOT 7UB SPOOPA
4i AGE RETAINING WALL/
I'"PonT ROCKERY El RENEWAL
EXPLAIN:
SPECIAL INSPECTOR
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REOU RED
❑ YES
AREA
LOADPANT
REMARKS
PROGRESS INSPECTIONS PER UBC 305
(TYPE OF )qE BUSINESS GR ACTIVITY)
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OF
ell', IES
INUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
OE RISE WORK TO BE DONE (ATTACH PLOT PLAN)
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FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HET r SOURCE
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PLUMBING
Plan Check NO
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curCs, sidewPlks,
driveways, marquees, etc.) will require separate pefmIsSion.
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
END. INSPECTION FEE
successors m interest, agrees to indemnify. defend and hold
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harmless the City of Edmonds, Washington, its Officials,
employees, and agents from any and all claims for damages of
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whatever nature. arising directly or indirectly from the issuance
DI this permit. Issuance of his permit shall not be deemed to
PLAN CHECK DEPOSIT
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modify, waive or reduce any requirement of any city ordinance
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nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that 1 have read this application; that the
ATTENTION
APPLICATION APPROVAL
Information given is correct; and that I am the owner, or the duly
D1 the owner. diagree to comply with city and
THIS PERMIT
until
authorized agent
state laws regulating construction; and In doing the work authoriz•
AONLo?IHEs
This application is not a permit
signed by the Building Official or his/her
etl thereby, no person will be employed in violation of the labor
YYLRK NorED
Deputy: and lees are paid. and receipt is
Code of the State of Washington relating to Workmen's Compensa•
acknowledged in space provided.
lion Ins r ante and RCW 1 7.
INSPECTION
- - ,v I OR AGEN OAiE IGNE
OEPP RT MENi
OFF UPE o TE
CITY OF
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EDMONDS
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CALL FOR
ELEAS r BY VDATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
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11 ORIGINAL — c•,e YELLOW —Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
Assessor
CHAPTER 3.
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