20030840.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. 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 CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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PERMIT EXPIRES
PERMIT &
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NUMBER
SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT N(7.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW Permit Required
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Street Use Permit Rsq'd
EXISTING ROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required
METER
LINE SIZE
OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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VALUATION
PLAN CHECK FEE-';
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
-&TAlt SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUE
FEE
I HEREBY AUKNUWLt:U0F THAT I HAVL HEAD THIS AFFLIUAI 1UN; I "Al i mr iNr%j"nnr%1 1UN
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
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 TH WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building official or his/her Deputy: and Foos are paid. and
ION OF THE V
, r receipt is acknowledged in space provided.
IN VIOLAT BC CO E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKPIEN'S MPEN ANCE AND RCW 18.27.
MW ICIALS I ATURE DATE
SIG UP NE GEN DATE SIGNED (4: is I y
25) A,
all -
771 -�0220 RE�154SED BY
ATTENTION EXT 1333
771-0221
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL W4 3 //Z
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOVf- INSPIKT®R
CATE OF OCCUPANCY HAS B EN GRANTED. UBC SECTION 199 FAX PINK - OWNER - GOLD - ASSESSOR
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLIC&ION
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EXPIRATION DATE I C
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PROPERTY TAX,ACCOUNT 19ARCEL NO.
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PLUMBING MECH
ADDITION
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COMPLIANCE OR
CHANGE OF USE
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APARTMENT
SIGN
REPAIR GRADING
FENCE
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X
0 DEMOLISH 1--0 TANK
0
OTHER
o GARAGE 0 RETAINING WALL
0
RENEWAL
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CARPORT , RY
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(TY OF USE, BUSINESS OR ACTIVITY1 EXP�AIN:
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NUMBER
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UMBER
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DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
Ann _SS
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PLAT NAM EISUBDIVI SION NO. LOT NO. LID NO.
LID FEE $
TIESCP Approved
PUBUC RIGHT OF WAY PER OFFICIAL STREET MAP RW permit Required
Street Use Permit Rtq'd
EXISTING PROPOSED Inspection Required
P Sidewalk Required
underground
REQUIRED DEDRATION.— FT Wiring required
MET R
E SIZE NO. OF FIXTURES PRV REOUIRED
YES 13 NO E3
Uj
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
in
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE w
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VARIANCE OR CU SHORELINE OR ADBN INSPECTION NO
REOO 1PBOTED
YE NO
SEPA REVIEW jjd01GN AREA HEIGHT
COMPLETE I EXEMPT WL1%WED PROPOSED ALLOWED PROPOSED M
EXP M
LOT COVERAGE REQUIRED SETBACKS (FT.) PRopbsED SETBACKS (FT.) __4
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR 0
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
VALUATION FEE Z.
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PLAN CHECK FEE 01104.
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BUILDING
PLAN CHECK
VESTED DA I r
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
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PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT: I YEAR - PnOVIDED WORKJS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK 00 PINK PERMIT FOR MORE INFORMATION
5E, HEIRS, ASSIGNS AND SUCCESORS_
'APPLICANT. ON BEHALF OF HIS "OA HER �POU.
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD NARML�Sb THE CITY OF
NDSCAPING
2
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND �GENTr.,FROM ANY AND,,
INSPECTION FEE
L_
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
PERMIT SHALL NOT BE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT., ISSUANCE OF THIS
PLAN CHECK DEPOSIT
DEEMEDTO MODIFY, WAIVE OF1 AEDUCE'ANY1`1lEOUIREM ENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S AbILITY To ENFORCE ANY ORDINANCE PROVISION. -
RECEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPRdVAL
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
TION: AND IN DOING THIi6dRK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE/_AQCaCO.0E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or histher Deputy: and Foos are paid, and
receipt is acknowledged In space provided.
WORK AMPE NCE AND RCW 18.27.
4EN'S
CIALS 1, ATURE DATE
SIG UR NE GEN
DATE SIGNED
(425).
771-10220
REJItASED BY
ATTENTION
EXT 12133
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTPN HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW - TOR
CATE OF OCCUPANCY HAS E RANT . IBC SECTION ling
FAX
PINK -OWNER GOLD - ASSESSOR
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