20020267.pdf.1
AM DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ZIP
PERMIT EXPIRES
USN E M T
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JOB SUITEIAPT#
ADDRESS IV
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PLAT NAMEISUBDIVISION NO.____17�
UDNO�
LID FEE S
PUBLIC NIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED—
'�raan .I.
REQUIRED DEDICATION— FT —
METER SIZE
LINE 1111
110. 01 11—REI
I- REQUIR D
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YES E3 NO 0
REMARKS
OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAMIAGE
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ENGINEENIN.1
EVIIIIal�PlDfl
required on fuel-burniftag nInces in
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VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
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1 10 1
POSTED
STATE LICENSE NUMBER EXPIRATION 1ATEa
D
4 PROPERTY TAX ACCOUNT PARCEL NO.
(1f5t_11 ( Q=C)(!:) & oc)
SEPA REVIEW
COMPLETE EXEMPT
EXP I
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED PROPOSED
I
PUNS- "P6E .... NTIAL
.fir"FLU.111N. I E--
n ADDITION COMMERCIAL Ei C MPLIANCE OR
CHANGE OF USE
REMODEL APARTMENT
REPAIR GRADING El SIGN
0 FENCE
i _ X FT)
DEMOLISH 0 TANK 0 OTHER
[I GARAGE (3 RETAINING WALL
CARPORT ROOKERY RENEWAL
I- COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS IFT)
FRONT SIDE RUN
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
A PARKING I
EO'D I PROVIDED
LOT AREA
PLANNING REVIEWED By DATE
REMARKS
11 IF 111, 11111101 A 11PP11:
NUMBER NUMBER OF jr CRITICAL
AREAS
OF DWELL IW—
a' STORIES NITS ING NUMBER
CHECKE..Y
JTY���
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SPECIAL INSPECT(
REQUIRED 0 yE
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REOD
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Y WYN I
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING LOT SLOPE
PLAN CHECK VEIIEII DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
t: BEDDNEONPRIVATEP OPERITY ONLV. ANY CONSTRUCTION ON THE PUBLIC
X
Grading
Recording Fee
DOMAIN ICUPSS, SIDEWALK$, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
PERMIT APPLICATION: INDAYS
Engr. Review
City,9urcharge
PERMITUMMI YEAR -PROVIDED WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPUCAYT ON BEHALF OF HIS OR HER SPOUSE, HE AS. ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST' AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE OF TH S PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
TotalAmountDus
DEEMED TO MODIFY I OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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I Receipt # 7N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DULY THOAIZED AGENT OF
—
APPLICATION APPROVAL
T E OWNER, I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application 1, net a Pamir until signed by Me
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
F THE LABD CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Ol%lal or his/he, Deputy: and Fee, are puld, j
r .. pro.clun-ledgdi—p ... p—ldixf,
RKMEN'S OMPENSATIO==A3 Now 1827.
OFFlqfAL,
1='A 0 1 DATE SIGNED
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(425)
71 /!//N- - - -
7
771-0220
-IFLEA1.
.1 /DATE'
AT-TENTION
EXT 1333
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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PLUMBING:
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Rough -in ...................
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Commercial Final
HEATING:
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Gas Test ..............
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Gas Piping— ............... VIS
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EXTERIOR SHEATHING
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NAILING ................
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FRAMING ........................
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INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling insulation
0
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................