20030496.pdfI
DATE REOEIVED
[PERMIT EXPIRES
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USE PERMIT
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME F ByqINESS
PLAT NAME/SUBDIVISION NO. LOT N6. LID NO.
MAILING ADDRESS
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
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CF n A
Street Use Peffnit Raq*d
EXISTING — PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT Undorground
Wiring required 13
NAME METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
YESE3 NO 13
15
ADDRESS
REMARKS
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OWNEFUCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NRE CBLN
ENGINEERING REVIEWED B DATE
Cc ADDRESS
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FIRE REVIEWED BY DATE
CITY
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ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION D CWCKED BY VARIANCE OR CU R ADB# INSPECTION BOND
POSTED
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PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN ARM HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PRO BED
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p4p 70 t
EXP ,
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
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NEW 0 RESIDENTIAL PLUMBINGIMECH
ALLOWED FRONT
PROPOSED SIDE REAR FRONT URSIDE REAR
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ADDITION COMMERCIAL o COMPIL ANCE OR
CHANGIE OF USE
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REMODEL MULTIFAMILY SIGN
PARKING LOT AR EWED BY DATE
REOD PROVIDED P "a',
0 GRADING 0 FENCE
REPAIR
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CYDS ( X FT) REMARKS
[:] OTHER
la DEMOLISH 0 TANK
oGARAGE o REMINING WALL FIRE SPRINKLER
CARPORT
0
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ROCKERY FIRE ALARM
(7YP"F USE, B EXPLAIN:
M CHECKED BY TYPE JF CONSTRUCTION OCCUPANT
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GROUP
NUMBER NUMBER OF CRITICAL
OF WELLING AREAS q
STORIES
SPECIAL INSPECTION EA OCCUPANT
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UNITS NUMBER
REQUIRED LOAD
YES
DESCRIBE WORk TO BE DONE
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REMARKS
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PROGRESS INSPECTIONS PER USC 1108/FINAL INSPECTION REO'D
VALUATION
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Desciription FEE Description FEE
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Plan Check
State Surcharge
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HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUT14ORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
2
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
ERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
k)EE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT N BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
N INTEREWAGREES 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee Receipt # 2
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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
This application Is not a permit until signed by the
CALL
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 acknowiedged in space provided.
WORKMEN$ COMPENSATION INSURANCE AND RCW 18.27.
OFFICIA��IG DATE
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:S= oR(P
(425)
771-0220
REVf.fsED BY f f DATE
ENTION
EXT 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 --Yrl-14-IN ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER * GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING