20030520.pdfI
DATE RECEIVED [PERMITEXPIRES
L 1-3
11SE PERMIT
CITY OF EDMONDS ZONE NUMBER 24C)
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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NAME
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STATE LICENSE NUMBER tXPIF�AT16;1I DATE
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PROPER11 TAX ACCOUNT PARCEL NO
1:1 NEW
01"RESIDENTIAL
011PLUMBING / MECH
ADDITION
0 COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
I — X FT)
DEMOLISH
TANK
OT;TER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
F RE SPRINKLER
FIRE ALARM
frYPE OF USE, BUSINESS OR ACTIVW4 EVLAIN:
NUMBER -3
OF
NUMBER OF
DWELLING
I
RITICAL
AREAS
I M A -
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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LID FEE $
PUBLIC RIGHT OF PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
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Street Use Poffrift Req'd
EXISTING - PROPOSED
fnspftW Required
SidewalkRequLred
REQUIRED DEDICATION- FT
Underground
Wiring requIred
M
OF FIMHE2
PRV REQUIRED
YES NO E3
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PROPOSED SETBACKS (Fr.)
PROPOSEDI,
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LOT AREA
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CHECKED BY ITY 7 TFUFTION OCCUPANT
GROUP
SPECIAL INSPECT103N AREA OCCUPANT
REQUIRED LOAD
YES
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'O
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE
c4s
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLA14 CHECK NO:
VESTED DATE
.
Plumbing
Mechanical
THIS PERMff AUTHORIZES ONLY THE WORK NOTED. THIS PERMIIT COVERS WORK TO
23
BE DONE ON PRIVATE PROPERTY ONLM ANY CONSTRUCTION ON THE PUBLIC
DOMAIN
Grading
(CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATION:
Engr. Review
1180DAYS
ERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN isig 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
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS
Fire Inspection
Receipt #
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
Landscape Insp.
Total Amt. Due
116,
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I
Recording Fee
Recelp
I 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
APPLIZARON
APPROVAL
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
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LAO DE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged in space provided.
WORKMEN'S COMPENSAT I S NCE AND RCW 18.27.
SIGNATUJ (OWNER
DATE SIGUED
(425)
OFFICIAL URE, E
/1
71 -71Q1d
771-0220
—RiCE—ASED A�_
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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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES
GREEN - ACCOUNTING