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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER
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EXPIR—AT-10)ATE KED 8
PR 0
PROPERTY TAX ACCOUNT. PARCEL NO.
NEW j�NESIDENTIAL
0 PLUMBING/MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
1-1 REMODEL MUL
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0 11 REPAIR 0 GRADING FENCE
CYDS ( X FT)
DEMOLISH 0 TANK
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GARAGE RETAININGWALL
CARPORT ROCKERY
F RE SPRINKLER
FIRE ALARM
OF USE. BUSINESS OR Adl�_X
NUMBER NUMBER OF CRITICA�L,_
SF&g _/ DWELLING C 'TC
S 1,A7REAS
UNITS 4UM 8 lj2
NUMBEFCA?"
DESCRIBE WORK TO BE DONE
_S_
ULAZING % LOT SLOP
STED DATE
NO: I 1EVE.—
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T;
BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
1
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
1
5 PERMIT APPUCATION: ISODAYS
'ERIArr UMIr I 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
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 CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATIO
- DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THr N
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
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
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0*&&E (OWN% OR
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F PERMIT EXPIRES
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ZONE PERMIT
NUMBER
JOB
ADDRESS
S
PD�T NAME/SUBDIVISION NO.
LOT NOI
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Escp'vlxc�
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AW Permit Required
EXISTING — PROPOSED
Street Use Permit Rsq'd
Inspection Required
REQUIRED DEDICATION— FT
Sidewalk Requxed
umierwoxw
wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION
CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VA IANCE OR CU
SHORELINEORADB#
INSRECTION
BOND
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POSTED
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NO
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$
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
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ALLOWED PROPOSED
HEIGHT
ALLOWED, PROPOSED
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5
LOT COVERAGE
ALLOWED
REQUIRED SETBACKS (Fr.) --
PROPOSED SETBACKS (FT,)
PROPOSED
0
FRONT SIDE REAR
1
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PARKI REA
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PROVIDED
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CHECKED BY ITYPE OFVCONSTR ON CCUPA��
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ZPECIAL INSPECTION OCCUPANT
QUIRED r] YES JAREA09k LOAD
REMARKS
PROGRESS INSPEC"ONS PER UBC 11081FIN AL INSPECTION REGID
FEE Desc
Descriptioln.LrIption FEE
St
Plan Check State Surcharge
ity Su
Building Pe rmit City Surcharge
Plumbing '�Iolfi
Mechanical or,
Grading
Engr. Review
Engr. Inspection
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.. Ov ew
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
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APPLICATION APPWO—V—A—L—r
CALL
This application is not a permit until signed by the
FOR INSPECTION
Building Official or his/her Deputy: and Fell$ are Paid, and
receipt is acknowledged In Vaca provided.
OFFICIALS SIGNATURE
,,� DATE
V(42.5)
2W 03
771- 20 1�
LC FIJI, 13Y D
ATTENTION
IT IS UNLAWFUL TO USE on OCCUPY A BUILDING on STRUCTURE UNTIL Off 1333
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL on A CEnTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAi ILE - YELLOW - 14SPECTOR
04/02 PINK - �� GOLD -ASSESSOR
PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -�CCOUNTING
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