20030206.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
15
MAILING ADDRESS
CITY
NAME
ADDRESS
CITY
NAME
ON 1i C_
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RESS
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CITY
CENSE NUMBER
ZIP TELEPHONE
ZIP ITELEPHONE
51
f
LEPHONE
Izilpt I TE 414� 491
EXPIRATION OPTE
c� T C� I 9-ft
NEW
RESIDENTIAL
2�1,
ADDITION
COMMERCIAL
REMODEL
0 MULTIFAMILY
REPAIR
[3 GRADING CYDS
DEMOLISH
*,TANK
oGARAGE
RETAINING WALL
1:3
CARPORT
ROCKERY
(ME OF USE. BUSINESS ORW7 LAIN:
C
NUMBER
-
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING %
PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
L.J ( __ X FT)
X 017EA
FIRE SPRINKLER
FIRE ALARM
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
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JOB SUITM
ADDRESS 101 Pf PL
PLAT NAME/SUBDIASION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit R."d
EXISTING — PROPOSED Inspection Required 13
SidirwalkRequited 13
REQUIRED DEDICATION— Fr UnderWourid
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YESD NO E3 z
REMARKS 11
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
FIRE M
NT FOR
DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADB N
INSPECTION
BOND
I REO'D
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POSTED
I
13YEs ONO
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOS ED
ALLOWED PROPOSED
,
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
PARKING
LOT
DATE
REC`D 1
AREA
I PLANNING REVIEWED.BY
1116
CHECKED BY Typ
PE
OCCUPANT
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-GROUP
CRITICAL
AREAS
SPECIAL INSPE IN REA
OCCUPANT
NUMBER
REQUIRE
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D.
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VALUATION
$
Description FEE
Description FEE
Plan Check
State Surcharge
LOT GLOPE %
Building Permit
City Surcharge
5—
VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPEMY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) W1LL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICAT11OW. 180DAYS
06 PERMIT IUMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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
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
91 DEEMED TO MODIFY; OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
WAIVE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
NJ
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
'ON
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TI
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
)Y
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
_35gKMENS COMP5WWftR"kSURANCE AND RCW 18.27.
0ATURE (OWN OR DATE SI�NED
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Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
LICATION APPROVAL
pation Is not a permit until signed by the
alorhistherDe I and Fees are paid, and
PUA space provided.
k Is acknowledged
Q&TURF 11 -.;Z I DATE.
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 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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Date Si
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