20020294.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNEFIrMEINAME OF B SINESS
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PLAT NAME/SUBDIVISION NO. I LOT NO* LI NO,
LID FEE It
PUBLIC IGHT OF WAY PER OFFICIAL STREET MAP Iw �."A' %.11111ss
EXISTING — PROPOSED -
REQUIRED DEDICATION— FT —
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REMARKS
nVINFRICONTRACTOR RESPONSIBLE FOR EROSION CONMOUDRAINAGE
NAME
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ALLOWED PROPOSED
PROPF�� PARCEL NO.
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NEW I MAESIDENTIAL PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE BUR
PROPOSED SETBACKS (FT)
FRONT URSIDE BEAR
ADDITION COMMERCIAL o COMPLIANCE OR
CHANGE OF USE
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PARKING
REaD I PROVIDED
LOT AREA
PLANNING.REVIEWED BY DATE
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REMARKS
(3 DEMOLISH 0 TANK E] OTHER
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CARPORT 0 ROOKERY 0 RENEWAL
(TYPE OF USE. BUSINESS ORe
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NUMBER OF I
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Description
FEE
Description
FEE
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Plan Check
LET SLOPE
OURCE GLAZING % LOT 'Lop,
Building
PLANCHECKNO: VESTED DDATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVE2AS�WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
LL E
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) VII REQUIR
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PERMMAPPUCATION: IN DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STA ID WITHIN IN DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPUCAW. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
E , 11 OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
LL CLAIMi FOR DA ES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
—
I
ROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total A...Rt Due
EEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
OR LIMIT IN ANY WAY THE CTIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION�
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Landscapeins
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I Am THE OWNER. OR THE DULY AUTHORIZED AGENT OF
This appli-aflon Is nol a patmit 11 sighed by Ihe
THE OWNER. I AGREE WITH CITY AND STATE LAWS REGULATING CONSTRUC-
To COMP
AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
fho". F.
dR.9 GOMM 01 his phy:.d s.P.kL.hd
TION:
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMENSICOMPENSATIO AND CW 1 7.
OFFICIALS SIGNATURE DATE
(OWNE G DATE SIGNED
(425)
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771-0220
RELEASED - D E
ATTENTIOW_
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-
ORIG HAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
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Gas Test ....................
Gas Pl,ln . ............
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EXTERIOR SHEATHING
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NAILING .........................
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INSULATION ...................
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SHEETROCK NAILING
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SPECIAL INSPECTION
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