20030664.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER,NA-MEINAME OF BUSINESS
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CITY ZIP ITELEPHONE
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ADDRESS
CITY I I - ZIP I TELEPHONE
NAME
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE C
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ROPEFTAX ACCO r PAR71. N
E] NEW
RESIDENTIAL
PLUMBING/MECH
[3 ADDITION
COMMERCIAL
COMPLIANCE OR
El CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING CYDS FENCE
( _ X_FT)
DEMOLISH
TANK
o OTHER
GARAGE
CARPORT
o RETAINING WALL
ROCKERY
o FIRE SPRINKLER
FIRE ALARM
(TYPE Ot USE. RMNESS ACTIMITY'l V(PLAIN:
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NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUURFR
DESCRIBE WORK TO BE DONE
'IF
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PERMIT EXPIRES
I
USE PERMIT
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NUMBER
JOB
SUITE/APT#
ADDRESS
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPfOvOd
RW Parrnij Required
Street Use Peffnit RWdT
EXISTING - PROPOSED
Inspection Rj&ftd
Sidewalk Re Ired
REQUIRED DEDICATION-
FT
Underground
ired 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES NO 13
kCTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
as
BY DATE
FIRE REVIEWED BY DATE us
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VARIANCE OR CU_j_iHORELINE
OR ADS#
INSPECTION
BOND
REQ'D
113YEs
POSTED
IS,
13NO
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED I PROPOSED
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I safir -1
LOT COVERAGE
REQffV%qjWs
I ?
W10
R gPENSETBACKS (Fr)
R SIDE REAR
ALLOWED PROPOSED
el?RFA
AP
PARKING 11"L&
AR&jtPLXrNING
REVIEWED BY DATE
RECID I PROVIDED
REMARKS
CHECKED BY JTYP!��ION OCCUPANT . L1,714
GRO
SPECIA. INSPECTION JAREA OCCUPANT
REQUIRED[:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER USC I 08/FINAL INSPECTION REG'Dj
$
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
BE DOME ON PRIVATE PROPERITY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
a
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
3
t:
SEPARATE PERMISSION.
Engr. Review
15
PERMITAPPLICATION: 160DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS 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
Receipt #
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARIISING 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
Landscapeinsp.
Total Amt. Due
Receipt #
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee
I HERE13Y 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 Official or his/her Deputy: and Fees are paid, and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
IN VIOLATION OF THE
WORKMEN'S C�WPV ATION INSURA.%E AND RCW 18.27.
omcl S�IGTUR�, *TE
DATS. MANED
( NER AGEN xWv-,
(425)
S�IG� d
771-0220
RELEASED BY DATE
ATTENTION
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 - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
ARE MAKING 5 COPIES GREEN - ACCOUNTING
04/02 PRESS HARD -YOU
1
TO:
-DATE:
MEMO TO: PETOORD ll;�DING DIVISION
FROM. -FIRE DEPARTNIENT DATE to
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-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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