660 BELL ST';DAT
CITY OF. EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY
TELEPHONE
NAME RECLIVED
ADDRESS
CITY
ZIP
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PER.ITEXPIRES
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ZONE PERMIT
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NUMBER
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JOB SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
JA
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
0
0
EXISTING PROPOSED
Street Use Pennit Req'd
inspection Required
(3
0
Sidewalk Required
Underground
0
REQUIRED DEDICATION— FT
wiring required
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES C-) NO 0
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9
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REMARKS
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OVINER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
0
A
NAME
ENGINEERING REVIEWED/DATE
ADDRESS
FIRE REVIEWED BY
DATE
UJI
CITY ZIP
TELEPHONE
/2—
STATE LICENSE NUMBER
EXPIRATIONDATE
CHECKEDBY
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
BOND
POSTED
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1,,,1,7Z, '��
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0 YES 0 NO
SEPA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
PR
ALLOWED OPOSED
HEIGHT
ALLOWED PROPOSED
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n
CL
iROPERTY TAtIACCOUNT PARCEL NO.,
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f NEW 0 RESIDENTIAL PLUMBING MECH
Ei COMPLIANCE OR
ADDITION C] COMMERCIAL CHANGE OF USE
C] REMODEL APARTMENT C] SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR
PARKING
REO'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
0 REPAIR E] GRADING
C] FENCE X
CYDS FT)
REMARKS
DEMOLISH TANK
HER
GARAGE ROETAINING WALL RENEWAL
CARPORT 0 R CKFRY
(TYPE OF USEEr OR ACTIVITY) EXPLAIN:
CHECKEDBY
ITY CONSTRU TION
DI)
OCCUPAN
G ROUP
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5
C,
NUMBER
OF
STORIES
NUMBERGI
DWELLIN
UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTOR
REQUIRED [3 YES
JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE zlz�
REMARKS
ROGRESSINSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
to
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE GLAZIN G % LOT SLOPE %
I BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t B E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, IMAROUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Vzns FICHARGE
cc PERMIT APPLICATION: 180 DAYS
W
0. PERMIT LIMIT: I YEAR - PROVIDED WORIK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 *APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
.41 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUI REMENT OF ANY CITY ORDINANCE
I
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
—
RECEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLIC&ION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
r9ceipt is acknowledged in space provided.
WORKMEN'S COMPE�VTION INS�eNX2W 18.27.
OFFICI Sit D E
SB'Y5
E
SIG 6�r�O R A �GAI
ATE S D
(425)
AEAS
771-0220
6ATE
0 BY----'
E L E 0
EaUTION'z
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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