20020971.pdfDATE RECEIVED i I
2 PERMIT EXPIRES
U'EE PER
N UM
CITY OF EDMONDS IN BE R
CONSTRUCTION PERMIT APPLICATION 'AODDRESS SUITEJAPT#
PLAT NAMIUSUDDIVISION NO. I LOT NO, LID NO.
MAILI G ADDRESS ". FEE
650 S7— PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCI All —ea
NW Fe- a. .,,.a
a.
ZIP JTEUEPHON� EXISTING — PROPOSED —
REQUIRED DEDICATION— FT undanarrell
— I rna _
NAME METER SIZE I LIN. SIZE NO. OF FIXTURES PAV REQUIRED
___ 4_, YES E3 No C3
ADDRESS IDE.A.I(a
NERICONTRACTOR RESPONSIBLE FOR EROSION LONTSOLJDRAINAGE
I
CITY ZIP
ROPER TAX ACCO
.;, V--) 34 (YJO
0 NEW
*.-IDENTIAL
0 LUMBINGIMECH
0 ADDITION
COMMERCIAL
COMPLIA CEOR
1:1 CHANGE OF USE
[3 REMODEL
MULTIFAMILY
[-] SIGN
M REPAIR
0 GRADING CYDS
X1 )aU F1
E] DEMOLISH
TANK
ri OTHER
o GARAGE
CAR PORT
RETAINNG WALL
ROOKERY
o FIRE SPRINKLER
FIRE ALARM
DESCRIBE WORK TO BE DONE
FIRE REVIEWED BY DATE
VARIANCEORCU I SHORELINE OR ADII I INSPECTION BOND
REOTI Fc.TED
Oves ONO s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
_XP
LOT COVERAGE REQUIRED sETeAcKs (Fr) PROPOSED SETBACKS (FTt
ALLOWED PROPOSED FROM SIDE REAR FRONT Lin SIDE REAR
PARKING I LOT AREA I PLANNING REVIEWED BY DATE
CHECKED BY 17j6OWN I CODE 0 UPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED F-3 YES LOAD
1EMA KS
PROGRESS INSPECTIONS PER UBC 108/11FINAL INSPECTION RECrD
-76
UATION
$
I
F_
Description
I
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE %
B uilding Permit
City Surcharge
PLANCHM VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED, THIS PERMIT COVERS WORKTO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTA CTIONONTHEPUSLIC
2
Grading
61
,, DOMAIN (CURBS, DEWALKS. DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
t: SEPARATEPEAMiSSION.
Engr. Review
PER ITAPPLICATION: ISDIDAYS
PERMITUM .1YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APIUCANT, ON 111111101 HIS OR HER SPOUSE, HERB. ASIIGNI AND I3U.C.I.Re
IN INTEREST. AGREED TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY 01
Fire Review
Plan Chk, Deposit
EDMOND S' WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt P
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
Landscape Insp.,
Total Amt. Due
0 1WAIVE
NORLIMITINANYW THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
ml
Recording Fee
Receipt #
I HERE 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
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
application "a permit 0 Mglad by Line
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Ifir"I ' he' napery: and Fees are paid. and
do, 1. a
FOR INSPECTION 10 la a ine'a On, glLdV,
WORKMENS =SATIO 11 SURANCE AN0,RCW 16.2T
OFFI A SIGNAT
1
(425)
771-0220
ATTENTION
09 1333
*EASED BY TI
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INIPECTZR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER COLD - ASS SSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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