20030601.pdf00 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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USE PERMIT 6Y
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Streal Use Permh Raq'd
EXISTING — PROPOSED
Inspeclion Required 13
Sidewalk Required 13
REQUIRED DEDICATION- FT
Undo(Wound
[ring required 0
METER SIZE
LINE SIZE
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NO. OF FIXTURES
PRV REQUIRED
43
YES13 NO 13 25
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
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LOT COVERAGE REQUIRED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIFISIDE REAR
13 ADDITION
COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
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REMARKS
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RETAINING WALL
13
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DESCRIBE WORK TO BE DONE
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REMARKS
PROR§ESS INSPECTIONS PEB UBC 11081FINAL INSPECTION REO'D
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Plan Check
State Surcharge
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HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge 1q.
PLAN CHECK NO: VESTED DATE
Plumbing
MU �L
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPEM ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
IL PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 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
F re nspection
i I
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due q
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
I
IN R LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt # �
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPffovAL
GIVEN 19 CORRE" 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
IN VIOLATION OF THE LAW"rMPE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Fees are paid , and
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATPI+INSUF�NCE AND RCW 18.27.
OFF[ SIG*TURE D7TE
GNATURE (OWNEfI tR IGVNT) DATE SIGNED
(425)
771 -0220
RELEASED BY A
A, VTT FE":N T; b N
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-
ELLOW/INSPI(CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING