20030002 (2).pdfDATE RECEIVED
CITY OF, EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL 0 PLUMBING MECH
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NUMBER
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PERMIT EXPIRES o�?
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NUMBER
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PLAT NAM E/SUBDIVI SION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required C3
Street Use Permit Req'd 0
EXISTING - PROPOSED
Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION�
FT
Underground
Wiring required (3,
METER SIZE
LINE SIZE
I
OF FIXTURES
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PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FIRE REVIEWED BY
VARIANCE OR CU I SHORELINE OR ADB#
DATE w
INSPECTION BOND
REO'D POSTED
(3 YES 0 NO I -
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
I
,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
PARKING
LOTAREA
PLANNING REVIEWED BY DATE
i
REO'D I PROVIDED
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c ' 0
CHECKED BY TYPE O=, OCCUP
GROUP:I�
S I __JAREA OCCUPANT
PECIAL INSPECT
a I LOAD
REQUIRED 0 �YES
ft tREMARKS 0
PROG9
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
"RMIT LIMIMI YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCEANY REQUIRI-MENTOF ANY CITY ORDINANCE
0 NOR LIMIT INANYWAYTHE CITY'SABILITY TO ENFORC_: ANYORDINANCE PROVISION.'
I HEREBY 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 AGREFr "r MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOINeT"t WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION V TV LABOR CODE OF THE STATE OF WASHINGTON RELATING To
WORKMEN'S SATION I
_ "U rE AND RCW 18.27.
SIGNATU WNER DATE SI IED
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2!E5
AVENTION
IT Ib 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
5/98
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
(425)
771-0220
EXT 333
771-0221
FAX
VALUATION
U"10
FEE
ation is not a permit until signed by the
I or his/her DQputy: and Foos are paid. and
is acknowlo/*d in spacoprovidod.
;IATURE PATE
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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