20030225A.pdfU111111
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAtEfNA
ME OF BUSINESS A
MAILING s
CITY1--VT
TELEPHONE
-771
NAME
ADDRESS
CITY
ZIP
TELEPHONE
NAME
CITY , ZIP I TELEPHONE
IPERMI'T EXPIRES
USE i�, X PERMIT
ZONE
07 NUMBE
JOB
SUITE/APT# I
ADDRESS
PLAT NAME/SUBDIVISION NO..
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IFIES.P'.A.11.
=.
RW ,
EXISTING — PROPOSED
Street Use Pemil R"'d
Inspection Aequired
Sidewalk Requked
REQUIRED DEDICATION— FT
UndergmuM
WkIngrequired 13
METER SIZE
LINE SIZE
-N�
0 FIXTURES
PRV REQUIRED
I-
YESM NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
--d
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR Cu
SHORELINEORADB# INSPECTION BOND
REQ'D POSTED
is
I
13YEs ONO
AC
)ROPERTY TAX A -SP
NT. PARCEL NO.
asew
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
ass.,
EXP
NEW
ADDMON
REMODEL
REPAIR
RESIDENTIAL
0 COMMERCIAL
[] muLnFAmII.Y
GRADING CYDS
PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
X Fr)
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REOD I PROVIDED
REMARKS
DEMOLISH
0 TANK
OTHER
oGARAGE
CARPORT
[:] RETAININGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSJWSS
OR ACTIVITY) EXPLAIN:
carAffloft-- CHECKED BY TYPE ZO ON OCCUPANT
NUMBER NUMBER OF
OF DWELLING
S JES
TOR UNITS
DESCRIBE WORK TO BE DONE
j CR
AR
NU 1E
I
SPECIAL INSPECTION'
REQUIRED 0
GROUP jo��
ARE A OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 110111MINAL INSPECTION REO'D
I 27/)m Yv,14 &JIV A AA.17 - /7
VALUATION
IL $
goa 00=
Y=c 7==3= 1—. J
Ta&MAMG :-Description FEE Description FEE
,44-�k� 7V Plan Check State Surcharge
i% LOT SLOPE %
Building Permit 4IL12 City Surcharge
CHECK NO- VESTED DATE Plumbing
RA k. ; I
THIS PERMIT AUTHORM6fS (ONLY THE WORK NOTED. THIS PERmrr COVERS WORK TO
1:
BE DONE ON PRIVATE PROPERTV ONLX ANY CONSTRUCTION ON THE PUBLIC
2
3
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
1=
SEPARATE PERMISSION.
a
PERMIT
Engr. Review
APPUCATION: I SO DAYS
ILIMM I YEAR - PROVIDED WORK 19 STARTED WITHIN IGO DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEIRALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan C k. 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 #
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 ORDINAN E
C
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Recording Fee
Receipt # [,QZ 2
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: T HAT THE INFORMATION
GIVEN 13 CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
"unn AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
This application Is not a permit until Signed by the
IN VIOLATPON-0 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or hill/her Doputy: and Fees are paid, and
Z17), receipt Isacknovdodged Inspaco provided.
C_f
WO!qM' SATICN INSURANCE AND RCW 18.27.
SIG
1A0 I
LS SqqNjTURE DfE
A A
2zrml-
MR
771-0220
0 &
---Wln-
'TVF�NTION
-EL, ASD or
Off 1333
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
ORIGINAL -FILE YELLOW- INSPECTOR
04/02
PINK -OWNER GOLD -ASSESSOR
PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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