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DATE RECEIVED
1 PERMIT EXPIRES
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CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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OWNER NAMEINAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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MAILING ADDRESS
LID FEE $
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IREMARKS
ILBCF Approved
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
CITY ZIP TELEPHONE
lie Permit Req'd
EXISTING PROPOSED Inspecdo Required
SidewalknFl*quired
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REQUIRED DEDICATION— Fr underground
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NAME
METER SI ZE LINE SIZE PRV REQUIRED
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ADDRESS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME BLO
70.
ENGINEERING REVIEWED BY DATE
ADDRESS
CITY I TELEPHONE
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I :WED BY DATE
FIRE REVjk
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STATE LICENSE NUMBER EXPIRATION DATE Y
VARIANCE OR CLI SHORELINE OR ADS INSPECTION BOND
REO'D POSTED
ATNAUF`i> VM4-
13YE6 13NOIs
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUW PARCEL No.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
NEW RESIDENTM PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) - PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
13 CHANGE OF USE
REMODEL MULTIFAMILY 0 SIGN
PARKING LOT AREA PLANNING REVIEWED. By DATE
REOD I PROVIDED
116
GRADING o FENC
REPAIR CYDS ( — X—FT)
REMARKS
0 DEMOLISH TANK [3 OTHER
[3 GARAGE RETAINING WALL FIRE SPRINKLER
0 19
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR AC"M �N.
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CHECKED BY TYPE OF CONS)rRUCTION L OCCUPANT
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V/ I GROUP
NUMBER FNUIMSER OF
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OF Ad LUNG A EAS
SPECIAL INSPECTION JAREA OCCUPANT
STORIES NuMBER
REQUIRED 0 LOAD
YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER URC 1108/FINAL IN SPECTION REaD
VALUATION 00
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Description
FEE Description FEE
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Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge t
PLAN CHECK NO: VESTED DATE
Plumbing
17
Mechanical
THIS PIERIIIAIT AUTHORIZES ONLY THE WOgK NOTED. THIS PERMIT COVERS WORK T
BE DOME ON PRIVATE PROPERTV ON101t ANV CONSTRUCTION ON THE PUBUC
Grading
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERIAIT APPLICATION: 190 DAYS
PERMIT Llurr I YEAR - PROVIDED WORK 16 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HORS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit jW
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C17Y ORDINANCE
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NOR LIMIT IN ANY WAY THE CrTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Recording Fee
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Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAI:
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
This application Is not a permit until signed by the
AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building official or his/her Deputy: and Fees are paid, and
2TION;
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE A14D RCW 10.27.
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SIGNA E 0 E3R OE DATE SIGNED
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OFFICI to
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771-0220
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ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
'04& 40
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW . INACTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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