20020997.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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No.
PLAT NAMEISUBDIVISION NO. LOT NO. L
LID FEE $
TESUP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED Inspection Required
SW&watk Required
REQUIRED DEDICATION— FT Undefuround
Witing required 13
METER SIZE LINE SIZE NO, OF FIXTURES PAV REQUIRED
YES13 NO C3 z
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REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY DATE W
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VARIANCE -OR CUI
SHORELINEORADBN
INSPECTION
BOND
STATE LICENSE NUMBER EXPIRATION DATE
CH Y
REO'D
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POSTED
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13 YES �K
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SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
3,11(60 OU 1 /37-00
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EXP
N
RESIDENTIAL
PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT L/R SIDE REAR
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
VSIGN
PARKING
REOD DED
PROW
LOT AREA
P NNING REVIEWED BY DAT a.
11 REMODEL
0 MULTIFAMILY
I
1
L
REPAIR [3 GRADING
CYDS
C] FENCE X
( FT)
REMARKS
DEMOLISH 0 TANK
E] OTHER
ME -
GARAGE [3 RETAINING WALL
CARPORT ROCKERY
;IRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TRIA"
:)CCUPANT
0
T, z V ed � L 4
CHECKED BY
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GROUP "-IfUll
NUMBER
OF
NWUMBEIFIGOF �t4CRITICAIL
D ELL N
A REAS
'A
SPECIAL INSPECTION
OCCUPANT
—TORIES
UNITS
N UMBER
fT_
JAREA
REQUIRED [3 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REQ'O
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Description FEE
Plan Check
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
PLAN CHEC�� �JZ
VESTED DATE
Plumbing
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3
1:
SEPARATE PERMISSION.
Engr. Review
15
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
Landscapainsp.
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
X1
Recording Fee
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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
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TION; AND IN DOING THE WOR ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Bull In
IN VIOLATION OF THE LABOR�H OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMIPENSAT9*fNfiVRA E AND RCW 18.27.
OFF1
DATE SIGNED
(425)
771-0220
4E
I(TTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
Description
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
C TION APPROVAL
I I not a permit until signed by the
I or I j1hor Deputy: and Fees are paid. and
a ovAcdaud In spite provided.
k BY
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ORIGINAL - FILE YEdOW - 14ECTO
PINK - OWNER GOLD - ASSESSOR
GREEN ACCOUNTING
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