20030661.pdfIT EXPIRES
USE PERMIT
CITY OF EDMONDS
ZONE NUMBER C4&,!5
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO. LOT NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED
Inapecuon Required 93
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REQUIRED DEDICATION— FT —
Underground
Widng required 13
NAME
METER SIZE LINE i�TO- OF FIXTURES
PRV REQUIRED
YES C3 NO 13
ADDRESS
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ITELEPHONE
NAME
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MUST BE PRESENI EOR
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FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELRE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION
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REO'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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NEW RESIDENTIAL
PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
ADDITION COMMERCIAL
COMPLIANCE OR
CHANCE OF USE
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY
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RECID I PROVIDED
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GRADING
1:3 REPAIR CYDS
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REMARKS
DEMOLISH TANK
OTHER
GARAGE RETAJNINGWALL
CARPORT 0 ROCKERY
FIRE SPRINKLER
0 FIRE ALARM
OF_USE, BUSINESS OR T&q&EXPLAJN:
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NUMBER NUMBER bF
OF DWELLING
CRITICAL
AREAS 'V
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SPECIAL 114SPE 10 AREA OCCUPANT
LOAD
STORIES UNITS
NUMBER /
REQUIREE
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC log/FINAL INSPECTION REO'D
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Description FEE Description FEE
Plan Check I I State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit 16- City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBILIC
Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPUCATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICAN'L 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
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
17.4-0
FROM THE ISSUANCE OF THIS PERMFE ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt #
Recording Fee
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-
CALL
This application Is not a permit until signed by the
Building Otficial or hisfher Deputy: and Fees are paid, and
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
FOR INSPECTION
receipt Is acknowiedged In space provided.
WORKMEWS COMPENSIJ�NCE AND RCW 18.27 .
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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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