20030427.pdfI
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j DATE RECEIVED
CITY OF D* :D
CONSTRUCTION PERMIT
APPLICATION
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TELEPHONE
ADDRESS
CITY
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ADDRESS A
CITY
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STATE
�LICENSE NUMBER
ZIP
ZIP
03
TELEPHONE
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TELEPHONE
A'6. 61 tr?.8'3zf 9
EXPIRATION DATE r C1ift*60 BY
❑ NEW RESIDENTIAL
❑ ADDITION COMMERCIAL
❑ REMODEL ❑ MULTIFAMILY
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❑ REPAIR ® GRADING CYDS
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❑ DEMOLISH TANK
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❑GARAGE RETAINING WALL
CARPORT ❑ ROCKERY
(TYPE OF USE, BUSINESS OR AWrM %PLAIN:
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❑ PLUMBING/MECH
COMPLIANCE OR
❑ CHANGE OF USE
❑ SIGN
❑FENCE X
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❑ OTHER
❑FIRE SPRINKLER
FIRE ALARM
D PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
G
JOB SUITE/APT#I
ADDRESS,?36� dllll?;c
N * Mgr, y (%/�
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PLAT NAME/SUBDIVISION NO. LOT NO. FLIDO.E S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RWPepproved
RW Permit flequkod
Street Use Permit Req'd
EXISTING PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT Underground
Wiring required
METER SIZE I LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES 13 NO i3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
DATE
FIRE
a_
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FIRE REVIEWFA�K FILL, REMOVAL
OR nap
VARVT FORDATE
VARIANCE OR CU� SHORELINE OR ADBN INSPECTION BOND
REO'D POSTED
BYES 'NO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L1R SIDE REAR O
Y
a
PARKING LOT AREA PLANNING REVIEWED. BY DATE
REQ'D I PROVIDED
CHECKED BY
%i NUMBER Nl1M8ER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTOO
j STORIES UNITS NUMBER lk REQUIRED ❑ YES
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
S DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
�i PERMITAPPUCATION: 180DAYS
rz PERMIT UMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMOND% WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ilk 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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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
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 COS "bUSATIO)S•INSMRANCE AND RCW 18.27,
DATE
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr, Review
Engr, Inspection
OCCUPANT
GROUP
OCCUPANT
LOAD
3 PER UBC 10WFINAL INSPECTION REGI'D 9
FEE Description
State Surcharge
City Surcharge
FEE
Fire Review Plan Chk, Deposit
Fire Inspection Receipt N
Landscape Insp. Total Amt. Due —�
Recording Fee Receipt #
APPLICATION APPROVAL.
���� This application Is not a permit until signed by the
Building 010cial or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt IsacknoWlodgedinspace provided.
OFFIC IGN LIRE DA E
(425)7 1 1
771-0220 RE E S ATE
ATTENTION EX 1 1333
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
Date Sib$
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INSULATION
Floor Insulation
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Wall Insulation
Cel'Ing.Insulation
SHEETROCK NAILING ...
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SPECIAL INSPECTION
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MISCELLANEOUS
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FINAL APPROVAL FOR
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OCCUPANCY
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