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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWUA NAME 'NAME OF BUSINESS
CITY ZIP TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
Legal Description of Property - include all easements
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Tax Account
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Parcel
J' 7- 003—
1500'3No.
El NEW
`,4 RESIDENTIAL
O PLUMBING/MECH
OMPLIANCE OR
COMMERCIAL
CXANGE OF USE
j�ADDITION
Ir.,f REMODEL
APT SLOG.
SIGN
❑ GRADING
FENCE
❑
REPAIR
CYDS
i x_Fl
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
GARAGE
7_1 WALL/
CARPORT
ROCKERYRETAINING
❑ RENEWAL
NUMBER NUMBER oil
F CRITICAL(n'r
OFnn,rc DWELLING I An As
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USE
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PERMIT
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NUMBER'06
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ADDRESS
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.EGAL DESCRIPTION CHECK
SUBDIVISION NO
LIO N
PUBLIC RIGHT OF WAY PER OFFICIAL STREET
MAP
TESCPAPPrdred ❑
EXISTING
REQUIRED DEDICATION__
RW Par—, Requxed ❑
SIIeaIUee PeIm Req'd ❑
InilW11-RequKed ❑
PROPOSED
Sidewalk Requned ❑
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
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I YES ❑ NO ❑
VARIANCE OR CU
A� DBN
SHORELINE
SERA REVIEW
COMPLETE EXEMPT
l
EXP
i COVERAGE
ALLOWED PROPOSED
SIGN AREA
ALlOWEO PROPOSED
REQUIRED SETBACKS (Fr.)
ZFRONT S`I'DE REAR
HEIGHT
ALLOWED PROPOSED
PROPOSED SETBACKS(F7T
FRONT URSIDE REAR
LOT AREA
1 OR 1
q
REMARKS
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CHECKED BY
TYPE OF CO TR CTION COD
OCCUPANT
G
SPECIAL INSPECTOR
REQUIRED
❑ YES
A EA
C"
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
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VALUATION
FEE
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PLAN CHECK FEE
HEAL SOURCE
GLAZING
BUILDING��
Od
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on✓✓private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
rn
driveways. marquees, etc.) will require separate permission.
STATE SURCHARGE
V
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
—
successors In interest, agrees to indemnify, defend and hold
W harmless the Clty of Edmonds, Washington, its officials,
IYST/G n
i employees, and agents from any and all claims for damages of
a Whatever nature, arising directly or indirectly from the issuance
T of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
omodify, waive or reduce any requirement of any city ordinance
nor Ilmit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
�I
provision.''
1 hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree 10 comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz•
AUTHORIZES
T'lis application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the Slate of Washington relating to Workmen's Compensa.
wORK NOTED
Deputy; and fees are paid, and receipt is
lion insurance aria RCW .2T
INSPECTiON
acknowledged in space provided.
SI AT RE (OWNER O 4GE. DATE SIGNS
OE PARTMENT
,�'1
`y�
CITY OF
OFF( 1 SIGN E GATE
1iV/
EDMONDS
J�v �g
ENTION
CALLFOR
INSPECTION
RELEA ED BY DATE
)i/YI % //O
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 —oLL�.o
ORIGINAL — F,le YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
IgTer
PINK — Omer GOLD — Assessor
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