20030694.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEP NE
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NAME
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CITY ZIP
NAME
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CITY TELEPHONE
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STATE LICENSE NUMBER EXPIRATION
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PROPIERTY TAX_,ACCOUn PARCM NO.
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Ann RESIDENTIAL
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ADDITION
COMMERCIAL
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MULTIFAMILY
1:1 REPAIR
[j GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAININGWALL
ROCKERY
(ME OF USE. BUSINESS OR
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
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PERMIT EXPIRES
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USE ERFUT I ,
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JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Ap
RW P*rrn1tPF'1=11sd
street use PernIft 'eq d
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— Fr
underground
Wiring required 13
METER SIZE
LINE SIZE -7.
OF FIXTURES
PRV REQUIRED
YES 13 NO E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FIRE REVIEWED BY
DATE
DATE
VARIANCE OR CU SHORELINE Oil ADB11 I INSPECTION BOND
AP
v4K REO'D POSTED
, A I 13YEs 13NO $
SEPA REVIEW SIGN AREA HEIGHT
C70MPL E . EXEMPT I ALLOWED . PROPOSED I At LOWED , PROPOSED
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
PLUMBING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
I
FRONT LIRSIDE REAR
I
COMPLIANCE OR
0 CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED,BY DATE
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SIGN
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PROVIDED
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REMARKS III
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FIRE SPRINKLER
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FIRE ALARM
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CHECKED BY OCCUFA "' VIA
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CRITICAL
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AREAS
SPECIALINSPECTIbN JAREA OCCUPANT
IREMARKS
NUMBER
REQUIRED 0 YES LOAD
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PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REG'D_,
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Description FEE Description FEE
LAZING % LOT SLOPE % Plan Check State Surcharge
HEAT SOURCE Building Permit _62�_ y Surcharge I
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AtrTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCnON ON THE PUBUC
Grading
3 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Revimv
PERMITAPPUCATION: 180DAYS
PERMIT UMIT: I VEAR - 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
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. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATIO14 OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION.
WO%��SATION INSURANCE AND RCW 18.27.
CA
a G UR (OWNER AGENT)
VAI 4 blUft D
(4-25)
771-0220
(PEAS
S
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt III
AqMION APPROVAL
jonis ot a permit until signed by the
r:hiser Deputy: and Res are paid, and
. edoed in spaceixovIded.
BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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'DATE RECEIVED
.., CITY OF EDMONDS
CONSTRUCTION PERMITAPPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP ITEWLEP NE
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ADDRESS
CITY zip ITELEPHONE
NAME
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CITY
ZIP
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STATE LICENSE NUM13ER
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USE PERMIT
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JOB S FJn�:
ADDRESS_
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pam -At Required
SUW U" Permit Req'd
EXISTING - PROPOSED
Inspection Required
Sidewa* Required
REQUIRED DEDICATION- FT
undargrotew
wwarcquired 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES 13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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FIRE REVIEWED BY DATE V
TELEPHONE Z
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VARIANCE OR Cu SHORELINE OR ADBN INSPECTION BOND
EXPIRATION DATE 12120'13 POSTED
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
i(REMODEL
1:3 MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
[3 TANK
[3GARAGE
0 RETAJNINGWALL
CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR &CE4fflM-EjIUN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
M
13YEs ONO IS
9k, SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP .46
M
PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACIM- (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR M
0 COMPLIANCE OR
CHANGE OF USE J_ 0
C
PARKING E
06
SIGN REQ`D I PROVIDED
M M
FENCE =N
X_Fn REMARKS V
0 OTHER FT Ef% Z
[j FIRE SPRINKLER
FIRE ALARM
0
In
CHECKED BY TYPE OF CONSTRUCTION OCCUPANT
GROUP
CRITICAL
ITI
AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMBER REQUIRED LOAD
YES (1)
0
Fn
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION EGeD
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PAM
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VALUAnON
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Descrlptlon
FEE
Description
FEE
Plan Check
State Surcharge
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HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
M
Mechanical
THIS PEIU= AUMRMES OKLY WE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONUL ANY COUSTRUC771OW ON THE PUBLIC
DOiWN (CURBS, SIDEWALKS, DIINVIEWAYS, MA"QUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. RWew
PERMIT APPUCAT11O*-_ 1160 DAYS'
PERUIT UUM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACKOF PIINK PERMIT FOR MORE INFOWATION *
ON BEHALF OF NO OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
;APPUGAW,
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICtALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PE"(T. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
DEEMED TO MODIFY, WAIVE OR REPUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS,'ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION; THAT THE INFORMATION
GIVEN IS CORRECr. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTTIUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED TIIIEREBY, NO PERSON WILL BE EMPLOYED
SuIldh
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
wo SATION INSURANCE AND RCW 18.27.
A
SIG REk(oWNFR
DATF_ D
(425)
�GENT)
771-0220
AS
ATWNTION
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
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
191TION APPROVAL
;im n is at a permit untit signed by the
oy
rhI or Deputy: and Fees we paid, and
1. .
6 owedaed in space provided.
By
ORIGINAL -FILE YELLOW- INSPECTOR
PINK-OWNEn GOLD -ASSESSOR
GREEN - ACCOUNTING