20030112.pdf11
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
ADDRESS
PERMITEXPIRES
USE PERMIT
ZONE NUMBER
JOB SU[TEIAPT#
ADDRESS f
PLAT NAMEISUBDIVISION NO.
LOT NO,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AWOVIld
RW PO(RA AWIfed
Stfsel Use PsfmA Wd
EXISTING - PROPOSED
inspection ftquwod
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REQUIRED DEDICATION- FT
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WWO f&qL*6d 0
METER SIZE
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NO. OF FIXTURES
PAV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
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NAME
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ENGINEERING REVIEWED BY
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FIRE REVIEWED BY
CITY ZIP TELEPHONE
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VARIANCE OR CLI
SHORELINE OR ADIIII
INSPECTION
BOND
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED 13Y
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REQ'D
POSTED
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13YEs 13NO
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SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLETE EXFMPT
ALLOWED PROPOSED
AL LOWED PROPO D
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EXP
NEW
RESIDENTIAL
0 PLUMBING/MECH
LOT COVERAGE
ALLOWED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
ADDITION
COMMERCIAL
COMPILIANCE OR
1:1 CHANGE OF USE
PROPOSED
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SIGN
PARKING
REOD PROVIDED
LOT AREA
PLANNING REVIEWED ffft DATE IL
FENCY /
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REPAIR
GRADING CyDs
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REMARKS
DEMOLISH
TANK
'OTHER
GARAGE
RETAINING WALL
[3 FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
OWE OF USE. BUSI
OR ACTIV" EXPLAIN:
CHECKED BY
ITYPE OF CONSTRUCTION
Cog
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OCCUPANT.
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPECTION AREA
OCCUPANT
STORIES
UNITS
NUMBER n
REQUIRED [3 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REWID
VALUATION
Description
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Build! I ng Permit
PLAN CHECK NOV3 _el V? VESTED DATE
Plumbing
11
Mechanical
THIS PERMIT AUTHORUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTV ONVY. ANY CONSTRUCTION ON THE PUBILIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIMVAYS, MARQUEES. ETC.)WILL REQUIRE
SEPARATE PERMISSION.
t:
Engr. Review
PEFIMITAPPILICAYION: leDDAYS
CL PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WffHIN 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
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
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 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
a ONI)l OR AGENT) DATE7GNEj-
(425)
MIN
771 -0220
AtTENTION
EXT 1333
FEE Description FEE
State Surcharge
City Surcharge
r-1%,
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
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
8 1 a Nrmit unfil signed by the
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,I or hiZe, Deouty: and Fees are paid, and
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BY DATE
ORIGINAL -FILE YELLOW- INSPECTOR
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