20000009.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER
MAILING ADDRESS
CITY ZIP I TELEPHONE
ADDRESS
CITY
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CITY zip TELEPHONE
PERMIT EXPI=IRES
US
PERMIT
ZONE NUMBER
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ADDRESS 4 a Irk I () Z I K'
PI -AT NAMEISUBDIVISION 1,1..
LOT No*
LID NO,
1
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED —
REQUIRED DEDICATION� FT
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METSR$IZE
LINE SIZE
OF -
NO. 01 MIXTURES
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FIRE REVIEWED BY
DATE
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ION
SEPA REVIEW
COMPLETE EXEMPT
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SIGN AREA
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ALLOWED P Pos",
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RESIDENTIAL C] PLUMBING / MECH
LOT C VERAGE
ALLOWED 0 PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT UPSIDE REAR
C] ADDITION
C] COMMERCIAL o COMPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA PLANNING REVIEWED By DATE
REMODEL
C] APARTMENT 0 SIGN
AEG D I PROVIDED
REPAIR
0 (PENCE X FT)
C] GRADING CYDS X FT)
SMARKS
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GARAGE
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0 (TYPE OF USE, BUSINESS
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RETAtNIN),G WALL RENEWAL
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NUMBER
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NU OF
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NU Mee
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AREA OCCUPANT
LOAD
DESCRIBE WORK BE DO
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PROGRESS INSPECTIONS PE R UBC 1081FINAL INSPECTION REG
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VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE
GLAZING %
LOT SLOPE %
BUILDING
PLAN CHECK NO:
rEITED OAT'
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON 4LY. ANY CONSTRUCTION ON,THE EPU BLiC
R'VA E ROPER Y 0 LL A OUIRE
00 S, MARQUEES, ETC.)
MAIN CURBS S"'E"AL`�-2T�iVVN5L!�'!
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STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR" PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG, REVIEW FEES
;APPLICANT. ON BEHALF OF HIS ONRIFYiR SFEONUDSE HEI.R.S�D'SIGNS ND SUCCESOR5
DE �N HARMLESS THE CITY OF
ENG. INSPECTION FEE
LANDSCAPING
N INDEM .
INTEREST. AGREES TO G
,.MUS N TON, ITS OFFICIALS. EMPLOYEES ANDA ENTSFROM ANYAND
INSPECTION FEE
0 D RECTLYOR INDIRECTLY
ALL CiLAWSWDAZZMAGESOF WHATEVER NATURE, ARISING
NOT BE
RECEIPT
FnOM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR PEOL,CE ANY REQUIREMENT
ANY ORDINANCE PROVI SION.'
REG IPT
NOR LIMIT IN ANY WAY TH E CITY'S AS LITY TO ENFORCE
TOTAL AMOUNT DUE
I H ER EBY ACKNOWLE DG E THAT I HAVE READ THIS A)PPLICEATIUOLNY THAT THE INFORMATION
GIVEN IS COARECT!, AND THAT I AM THE OWNER. C ATH D AUTHOR', . AGENT OF
G B TATE LAWS RIDULA"NG CONSTRUC
CALL
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THEOWNER IAGREETOC LY WITH CITY AN
OMP T. BE E111-11
TION, AND IN DOING THE WORK AUTHORIZE SE.��Y. No F' ASON WIlL
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE 01 TH TATE OF WASH, �.To, RELATING
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WORKMEN-SCOMPENSATION INSURANCE ANDRCW 18.27.
(425)
FF LS N UP,
E SIG 0
771-0220
A L ASE. BY D E
ATTENTION
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
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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DEPARTMENT DATE—L�:�:�
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PERMIT _2 cL
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INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED Lf�,
A field insl)-ti- . (maducted to datertnine .plianc, witb.,pproved plans. Fmal approval denotes ffial
thm are no objectio- frO- the above signed Departineot to the 91tin8 of
��Fiml approval of the described work
erf',mce Bonds associated with the p_j-t -sy be released
_GRANT FINAL PROJECT APPROVAL
---jGRANT FINAL PROJECT APPROVAL WrM CONDITIONS NOTED
AILED FINAL INSPECTION OUTSTANDING ISSUES
3.
—RE-INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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