17107 72ND AVE W1111111111111114964
17107 72ND AVE W
USE ERMIT
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STREET ME*
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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NAME (OR NAME OF BUSINESS)
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LEGAL DESCRIPTIOWTREERK�ION
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NO.
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LID NO.
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
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APPROVED BY
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CITY
TELEPHONENUMBER
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NAME
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RIGHT OF WAY CONSTRUCTION PERMIT REOUIRED C
STREET USE PERMIT REOUIRED C
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ADDRESS,
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REVIEW BY SEE ENGINEERING MEMO DATED
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CITY
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TELEPHONE NUMBER
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REMARKS
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UREMARKS
ADDRESS
METER SIZE
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BUILDING SUPPLY FIXTURE
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UNITS
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TELEPHONE NUMBER
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STATE LICENSE NUMBER
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SIGN AREA
ALLOWED PROPOSED
ENV? -REVIEW
COMPLETE EXEMPT
ADB NO.
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Legal Description of Property - include all easements
(show.below or attach four copies)
SHORELINE
VARIANCE OR CU
PLANNING REVIEW BY
DATE
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YARDS
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SIDE REAR
LOT COVERAGE
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REMARKS
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9NEW 0 RESIDENTIAL aPLUMBING
ADDIALTER 1:1 COMMERCIAL E�MECHANICAL
REPAIR RETAINING WALL El SIGN
EXCAVATE FENCE
DEMOLISH OR FILL ( x _FT)
REMODEL E:] PRE -MOVE INSPJ swim
- COMPLIANCE INSP. POOL
CHECKED BY
TYPE OF CONSTRUCTION I.CODE
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198S
HEIGHT'
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SPECIAL INSPECTOR
REQUIRED
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AREA
OCCUPANCY
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OCCUPANT
LOAD
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❑ WOOD STOVE/ [:] APT.
INSERT RENEWAL
REMARKS
PROGRESS INSPECTIONS PER UBC 305
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NUMBER OF STORIES
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NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
GRADING/FILL
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year- Provided Work is Started Within 180 Days
ENERGY CODE
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors In Interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, Its officials_
employees, and agents from any and all claims for damages of'
whatever nature, arising directly or Indirectly from the issuance
CHECK DEPOSIT
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MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: 1710? %2nV11 AleE
After review of the subject building permit application, we have the
following comments:
1)
2)
3)
4)
5)
6)
7)
8)
9)
iv)
Connection to City' water system required.
Connection to City sanitary sewer system required.
Right-of-way permit -required for any work -on City property.
Driveway slope not to exceed 14a.
Back water valve required if downstairs plumbing is below.
elevation of upstream manhole.
Water and sewer lines to be separated by 10 foot minimum.
Builder/owner responsible for containing all •tempora.ry runoff and
erosion on site and may pot impact neighboring properties in any
way. •
Construction hours from7:00 a.m. to 10:00.p.n. on weekdays and
10:00 a.,im, to 6:00 p.m. on weekends and holidays.
No burning of construction refuse Vi thc,2-t--pr=rhsrA 1 by ri re Dept.
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