20030275.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESq
MAILING ADDRESS
CITY ZIP ITELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME jCBL#
ADDRESS
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER
NO.
NEW
RESIDENTIAL
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ADDITION
COMMERCIAL
REMODEL
MUL11FAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, W1§11NESS OR ACTINTM EXP
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UMBER
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N MBER OF NIA
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DESCRIBE WORK TO BE DONE
I PERMIT EXPIRES
USE PERMIT I —
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Street Use Peffntt Req'd
EXISTING — PROPOSED
Inspection Required 93
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
REMARKS
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OWNER/CONTRACTOR RESPO NSIBLE FOR EROSION CONTROUDRAINAGE
BY
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FIRE REVIEWED BY
DATE
DATE us
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VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
BOND
'ION DATE
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CHECKED BY
REO'D
IMYEs I
POSTED
ONO $
BEIRA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
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ALLOWED
PROPOSED
ALLOWED
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EXP
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L
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
PLUMBING / MECH
ALLOWED PROPOSED
A
FRONT SIDE REAR
FRONT
LIFISIDE REAR
COMPLIANCE OR
USE
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CHANGE OF
PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
SIGN
REDID
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PROVIDED_[
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I EMARKS
OTHER
FIRE SPRINKLER
FIRE ALARM
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AREAS — SPECIAL INSPECTIi5k JAREA OCCUPANT
NUMBER 03— REQUIREDE3 V9:.C% LOAD
REMARKS
PROGRESS INSPECTIONS PER ILIBC 1108/FINAL INSPECTION REaD
(to, Y2�1 ok U_F
$
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Description
FEE
Description
FEE
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Plan Check
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State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
-40-
City Surc harge
Plumbing
PLAN CHMNA. VESTED DATE
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMITAPPILICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
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Recording Fee
Receipt #
711
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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 CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
CALL
FOR INSPECTI ON
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1-0220
APPLICATION APPROVAL
This application Is not a permit until signed by the
B4kiir� �jaj50rChjn3jhajrDePUt and Fees are paid, and
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ATTENTION 11 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW :INSPEC70
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ADDRESS
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