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. FERMIT EXPIRES
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CITY OF EDMONDS
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USE PERMIT
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NUMBER
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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NAMENAIJE OF BUSINESS
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PLAT NAME/SUBDIVISION NO. -e0T NO. LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP ft "ZV
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Street Use Permil R&Q'd
EXISTING — PROPOSED inspection Required
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Sidewalk Required
REQUIRED DEDICATION— FT UndorgrOund
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Wiringfoquired
NAME
METER SIZE
LINE SIZE
NO.0 RES
PRV REQUIRED
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YES 13 NO 13
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADI INSPECTION 1$ BOND
'STATE LICENSE NUMBER EXPIRATION DATE CHECKED By. REQ'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
NEW RESIDENTIAL PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
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CHANGE OF USE
0 REMODEL MULTIFAMILY SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REQD PROVIDED
L1 REPAIR GRADING FENCE
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REMARKS
OTHER
DEMOLISH 0 TANK
GARAGE -1 FIETAININGWALL FIRE SPRINKLER
CARPORT 13
ROCKERY F19E ALARM
OF USE, SUPINESS OR ACTIV"i EXP Nq
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CHECKED BY TYPE OF CONSTRUCTION OCCUPANT
CODE
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CRITICAL
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OF DWELLING AREAS
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SPECIAL INSPECTION AREA OCCUPANT
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STORIE - NITS NUMBER
REQUIRED 0 LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC IDS/FINAL INSPECTION REaD
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Description FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK VESTED DATE
Plumbing 69—
9
Mechani Cal 116
THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION Oil THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRINIEVAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: ISO DAYS
IL
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
Engr. Inspection
SEE 13ACK 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISS UANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp. Total Amt. Due ///"5—
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
1
HEREBY
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
V IS
N
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
— i -- i 11
APPLICATION APPROVAL
E OWN
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This application Is not a permit until signed by the
CALL
ION; AN[
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Foes are paid. and
I N VIOLAI
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged in space provided.
LGE
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OF A NATUR DAIE
NAT (OWNER 0 GE DATE SIGNED
(42
11-7, 5 -/C)
771-0220
R BED BY /DATE/
ATTENY100
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IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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CATE
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
C�RIGINAL -FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING