20030258.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP I TELEPHONE
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STATE LICENSE NUMBER EXPIRATION
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
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PUBLIC RIGHT OF W PER OFFICIAL STREET MAP RW Permit Requir
street use Permit
EXISTING — PROPOSED inspection Required 13
Sid ew&lk Required 0
REQUIRED DEDICATION— FT underground
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NO. OF FIXTURES PRV REQUIRED
METER SIZE LINE SIZE
YESO NO 13 25
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE I I
ENGINEERING REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADBI INSPECTION 1$ BOND
BY REO'D POSTED
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INSPECTIONS PER UBC 11081FINALINSPECTIum nmu'u
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE T GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CZKN- VESTED DATE
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THIS PERMIT AUTHORIZER ONAHE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. E TC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERIMIITAPPILICATION: ISO DAYS
'500
ERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
In(,
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'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
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
2 NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPEROViiLE-_
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 CONSTRLIC-
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 provided.
WORKMYP COMPENSATION INSU CE AND RCW 18,27.
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ATTEUION
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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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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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YES13 NO 0
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
CITY ZIP ITELEPHONE
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NAME
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ENGINEERING REVIEWED BY
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FIRE REVIEWED BY
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CITY ZIP
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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1$ BOND
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CHANGE OF USE
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. PARKING
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LOT AREA
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REPAIR GRADING FENCE X FT)
CYDS
REMARKS
DEMOLISH TANK
77,11VIT/
Ei GARAGE o RETAININGWALL KIRE SPRINKLER
FIRE
CARPORT ROCKERY ALARM
(TYPE OF USE. BUSINESSM��'
CHECKED BY
TYPE 0 'IONS LICTION
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OCCUPANT
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NUMBER
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LOAD
DESCRIBE WOFf TO BE DONE r
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REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REaD
VALUATION
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411
$ V111il
mm
I =or
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CH K
/"12
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORENG DNING E WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, ORWMAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: ISODAYS
PERMIT IUMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
nr
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICiAK 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
a
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECnY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
21
NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANN ORDINANCE PROVISION.-
Recording Fee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT6 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
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
BuUdlng
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 provided.
WORKM�" COMPENSATION INSURANCE AND RCW 18.27.
0 IALS SIG ATURE 'PATE
BIG RE
JE SIG
DA NED
IA95)
Vwa
/ r/11
771-1;220
/DATE
RELfAtto
by
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL UR A CERTIFI- ORIGINAL -FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTiON 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS WARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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