20030239.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
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CITY ZIP TELEPHONE
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NAME CBL#
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JOB SUITE/APT
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe Approved O
RW Permit Required ((�]
Street Use Permit Roq'd
EXISTING PROPOSED Inspection Required p
Sidewalk Required 13
REQUIRED DE TI FT Underground
x Wiring required CI
METER SIZE LI I r: N PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION OL/DRAINAGE
C ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE iu
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION, DATEC BY VARIANCE OR Cu SHORELINE OR ADB# INSPECTION BOND
j RE 'D POSTED
, , 02"" / -01' a ❑YES O S
SEPA REVIEW SIGN AREA N HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP M � • S 18.
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRE6 SETBACK (FT.) PROPOSED SETBACKS (FT.)
/jA�LLOWED PROPOSED FRONT SIDE REAR FRONT �UR SIDE REAR
COMPLIANCE OR❑ ADDITION COMMERCIAL ❑ CHANGE OF USE / ` I w T �� G" ' `a" - E
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ® SIGN_ REQ'D PROVIDED
11❑ GRADING 13 FENCE X REMARKS U!
REPAIR CYDS
❑ DEMOLISH ❑ TANK 1:1OTHER
GARAGE RETA❑ FIRE
CARPORT ❑ R CKIERY NING WALL 1:1FIRE ALARM SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
A 5'+TA "�/D • A CHECKED BY TYPE OF 1U TI N C GROUP NT
NUMBER f•1 /NUMB/ERR OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
STORIES UNITS �. NUMBER 1v REQUIRED[:] YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REDID 9
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Description FEE Description FEE
RIer+6heck[Jq �' tCity
tate Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Perrr Surcharge
PLAN CHECK NO; I ' ' VESTED DATE plu tiR iinng
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
C BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
s Engr. Review
euj PERMIT APPLICATION: 18o DAYS
o PERMIT LIMIT. 1 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
s EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
S DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp, Total Amt, Due
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
_ Recording Fee Receipt #
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. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provid d.
WORKMEN'S COMPENSATIO NCE AND RCW 18.27. OF IALS SIG ATURE E
SIG URE (OWN O GENT)kma
DATES NED ^ (425)
771m0220 RELEASE BY 9ATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
ATTTION EXT 1333 /✓ '�1� 6' l "r , .
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - PLE4 YELLOW • INS ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 169. PINK -OWNER GOLD -ASSESSOR
04/02 1 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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