890256.pdfCITY OF EDMONDS
rl CONSTRUCTION PERMIT APPLICATION
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
REVIEW BY
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ALLOWED
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CARPORT ❑ SWIM
REMODEL GARAGEPOOL
❑ WOODIN ERT ❑ ROCKERYRETAININWALL/ RENEWAL
NUMBER OF STOR:TO
NUMBER OF
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PROGRESS INSPECTIONS PER UBC 305
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PLAN CHECK FEE
BUILDING
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N• � �vy GRADINGIFILL
This Permit covers work to be done on private prop
ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
IIIIIIIII
Permit Application: 180 Days ENERGY CODE
Permit Limit: 1 Year- Provided Work is Started Within 180 Days
'•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,
Limit
and agents from any and all claims for damages of
ature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
mit. Issuance of this permit shall not be deemed to
ive or reduce any requirement of any city ordinance TOTAL AMOUNT DUE
any way the City'sability to enforce an ordinance
I hereby acknowledge that I have read this application; that the ATTENTION
information given is correct; and that I am the owner, the idly THIS PERMIT
authorized agent of the owner. I agree to Comply with
city state laws regulating construction; and in doing the work authoror ONL�RTHEs
ed thereby, no person will be employed in violation of the Labor WORK NOTED
Code of the State of Washington relating to Workmen's Compensa- INSPECTION
tion Insurance. DATE SIGNED DEPARTMENT
71
SIGNATURJF.IOW R OR AGENT) / CITY OF
EDMONDS
7714202
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL OR
EC
CERTIFICATE INSPECTION
OFOCOBE EN ADE N
OCCUPANCY HAS BEEN
AGRANTED. ALUBC
CHAPTER 3.
102.87
TION
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OCCUPANT
LOAD
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4000
—100.00
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
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RELEASED BY:
ORIGINAL — File YELLOW — Inspe or Uj
PINK — Owner GOLD — Asse or