20030078.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN
NAME
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ADDITION
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PLAT NAME/SUBDIVISION NO. e6T NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Aw Permit Required
Sunal Use Parmh Req'd
EXISTING — PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT [ring required 13
METER SIZE LINE SIZE N�MURES PRV REQUIRED
I I YES)k NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE us
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VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
I REO'D I POSTED
_]E3YEs 13NO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS PROPOSED SETBACKS (FT.)
Lff PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR I
COMPLIANCE OR
0 CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWEO By DATE a
SIGN REOD PROVIDED 06
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OTHER
FIRE SPRINKLER
FIRE ALARM
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AREAS SPECIAL INSPECTION A A OCCUPANT
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REMARKS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REG
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Description �FEE Description FEE
Plan
Check
State Surcharge
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Building Permit
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City Surcharge
PLAN CHECK NO:
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Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRr4ATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
I DOMAIN (CURBS. SIDEWALX5, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
Iz
Engr. Review
I PERMIT APPLICATION: 160DAYS
CL PERMIT LIMM I 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
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
!3 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.*
x
Receipt #
Recording Fee
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit unlit signed by the
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
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In sRco' 9 rovId I
WORKMEN'S COMPENSAT!�J�SURANCE AND RCW 18.27.
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DATE SICOED
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771-0220
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RE94D BY DATE
ATTENTIM
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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 YELLCW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOLIWING
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CITY OF EDMONDS
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PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPCOVOd
RW Permit Required
u" Permit Raced
EXISTING - PROPOSED
Street
Inspect1cm Required
Sidewalk Required
ZIP
TELEPHONE
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REQUIRED DEDICATION- FT -
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underground
Wiringroquired
NAME
METER SIZE
LINE SIZE
P RV REQUIRED
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
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CITY ZIP
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VARIANCE OR Cu SHORELINE OR ADB# INSPECTION BOND
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SEPA REVIEW SIGN AREA HEIGHT
ERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
00 2a/ �42 14
EXP , , ,
RESIDENTIAL PLUMBING / MECH
LOT COVERAGE REQUIRED SET13ACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED �RONT SIDE REAR FRONT LIRSIDE REAR
ADDITION MMERCIAL COMPLIANCE OR
El OF USE
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CHANGE
PARKING LOT AR eA PLANNING REVIEWED BY DATE
REMODEL MULnFAMILY SIGN
REO`D I PROVIDED
GRADING FENCE
REPAIR CYDS' 0 ( x FT)
REMARKS T loop PM
DEMOLISH TANK E] OTHER
o.GARAGE RETAININGWALL F RE SPRINKLER
MEOW
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NUMBEq, NUMB CRITICAL
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STORIEk NITS NUMBER
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D.
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VALUATION
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Description
FEE
Description,
FEE
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Plan Check
State Surcharge
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B�ildlng Permit City Surcharge
PLAN CHECK NO:' VESTED DATE
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Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
'%,V a
t: BE DOME ON PRIVATE PROPERTY 6"I.Y, ANY CONSTRUCTION ON THE PUUILIC
IRE
Grading
3 DOMAIN (CURBS, SIDEWALKS. Dflr^VAVS. IAAPQUEES, E TC.) WIL4REQ
SEPARATE PERMISSION.
h
En9r. Review
PERMIT APPLICATION: 160DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WTFHIN 180 DAYS
Engr. Inspection
SEE BACK OF P114K PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
HINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Ins ctlon Receipt #
ALL CLAIMil FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
'pe
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp. Total Amt. Due
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DEEMED TO MODIFY, WAIVE 10R REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
�
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Record Receipt # '2 1,q?5�z
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN 18 CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
TIHE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
ThIS appIkowon-is Cot a Owmit until signed by the
CALL-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/hec-0eputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged InsjWce'0rovId9d.
WORKMENS COMPENSAT!5iAKURANCE AND RCW 18.27.
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S RE (OWNER 0 AGE DATE SIG �ED
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771-0220 —ErLk7 D B Y DATE
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ATTENfIW
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL t I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- INSPECTOR
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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