970822.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILLING AOOR/E/(B/S }(
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LICENSE NUMBER 1 EXPIRATION DATE �i � /
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TeX aceount 5319 o4 5 n0 I lea q
Parcel No. '
NEW RESIDENTIAL El PLUMBINGIMECH
CO PLIANCEOR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG. O SIGN
❑GRADING ❑ FENCE
REPAIR CY05. L—X_F
DEMOLISH ❑ WOODSSWIM POOL
INSERT HOT
HOT TUB/SPA
GARAGE RETAINING WALL/ l7,L,(IGARAGE RETAINING WALL �7 L�I• '7'J'h.Y.../
CARPORT II ROCKERY lei L
TYPE OF USE, BUSINESS OR,BGT�IIYyEi(PLAIN:
NUMB NUMBER OF �� CR ITICA Y Q
OF DWELLING AREAS �/%%
STORIES 1 UNITS NUMBER
DESCRi WORK TO BE DONE (ATTACH PLOT PLAN)
USE
ZONE
PERMIT
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1097_Z
NUMBER
JOB
ADDRESS
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AGAL DESCRIPTION
CHECK
SUBOIVIs ON NO
LID N10
PUBLIC RIGHT OF WAY PEI
OFFICIAL STREET MAP
TESCP Approved ❑
FIN Perm,, rl q—rid ❑
EXISTING
REQUI
ED DEDICATION
Street Uae Perm,, Req'd ❑
PROPOSED
Inspection Repuued ❑
S,dii Required ❑
METER SIZE
LINE
51ZE
NO. OF
FIXTURES
PRV REQUIRED
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I YES D NO ❑
VARIANCE OR CU
ADS N
SHORELINE N
SEPA REVIEW
SIGN
AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED
PROPOSED
ALLOWED
PROPOSED
EX I
LOT COVERAGE
REQUIRED SETSACKS(Fr.)
PROPOSED SETBACKS (FT)
ALLOWED I PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
LOT AREA
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CONSTR TION
CODE
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SPECIAL INSPECTOR
AREA
OCCU,PA�NTT
REQUIRED
El YES
LOAD
MAgKS
PROGRESS INSPECTIONS
PER UBC 108
FINAL INSPECT!
N REOUIRED
OF-'
PLAN CHECK FEE
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HEAT SOURCE:
GLAZING
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PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADNGIFILL
Any construction on the public domain (curbs, sidewalks,
STATESURCHARGE
driveways, marquees, etc.) will require separate permission.
Penult Application: 180 Days
PermlI Limit: 1 Year - Provided Work is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf Of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
w successors in interest, agrees to indemnify, defend and hold
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w harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
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
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 [
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
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authorized agent of the owner. 1 agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
AUTHORIZES
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
lion Insurance aria RCW 18.27.
INSPECTION
SIGNATURE O N R OR AGENT, GATE SIGNED
DEPARTMENT
�� � _/ S _/
CITY OF
EDMONDS
CALL FOR
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
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UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 -02'
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
SECTION 109
10287
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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.
1CIAL'S SIGNATURE DATE
ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor a
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FINAL APPROVAL
FOR OCCUPANCY ..........
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