20030862.pdfDATE REC:,jT PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO, I LOT NO. LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pernilt RBquk*d
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CITY ZIP 1LEPHO
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EXISTING PROPOSED Inspection Required
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REQUIRED DEDICATION FT— Underground
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COMPLIANCE OR
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REMARKS
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF AL
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
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Description FEE Description FEE
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Plan Check State Surcharge E
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit City Surcharge
PLAN CHECK No VESTED DATE Plumbing I q 4 - !A, --
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PER"IT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT! I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
Engr. Inspection
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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
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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 MATURE. ARISING DIRECTLY OR INDIRECTLY
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OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
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FROM THE ISSUANCE
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
NOR LIMIT IN ANY WAY THE
Recording Fee
Receipt #
'/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 C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
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
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged In space provided.
WORKMERS COMPENSATION INSURANCE AN
0 A 'IGN DATE
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DATE SIG4ED
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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DATE
CITY -OF EDMONDS 't.,
CONSTRUCTION PERMIT APPLICATION)
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CITY ZIP
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PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB
ADDRESS
PL
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIP Approved
RW Pern'At Required
et Use Permit R60
EXISTING PROPOSED
Inspection Required
SidewalkRequirsd
REQUIRED DEDICATION FT
Underground
Wiring required 13
METER SIZE LINE SIZE I NO. 0 FIXTURES P V REQUIRED
YESR[3 NO
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE Lu
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VARIANCE OR cu
SEPA REVIEW
COMPLE rE EXEMPT
EXP I %,,--
SHORELINE OR ADB# INSPECTION BOND
REOD POSTED
10YEs MAO s .0-10
SIGN AREA HEIGHT
ALLOWED , PROPOSED ALLOWED PROPOSED
a 25 9 1 Aff-
LUMBIN MECH
COMPLIANCE OR
USE
0 CHANGEOFUSE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT DE REAR
101
SIGN
PARKING
REQ`D PROVIDED
LOT AREA PLANNING REVIEWED BY DATE
. . 116
0 FENCE
X FT)
7-
REMARKS
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0 FIRE SPRINKLER
- FIRE ALARM
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NUMBER NUMBER OF CRITICA
OF DWELLING AREAS
STORIES UNITS LNUMBERd3 - 13-7
DESCRIBE WORK TO BE DONE
7
HEAT 8 RCE GLAZING % LOT SLOPE %
�75 (a 0 1 12 - f z' "r IVESTED DATE
THIS PERMIT AUT"ORIMES OMMY"R WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARQUEES, EFC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT ILIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN 18 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-
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
SPECIAL INSPECTION JAREA
REQUIRED [3 YES
REMARKS
PROGRESS INSPECTIONS PER UBC
VALUATION
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
OCCUPANT
GROUP
INSPECTION RECfD
FEE Description
State Surcharge
City Surcharge-
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt # ?'Vlel D
Landscapeinsp. Total Amt. Due IqZ, �T
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or histher Deputy: and Res are pald, and
F R INSPECTION1 receipt is acknowledged In space provided.
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WORKMEN'S COMPENSATION INSURANCE AN 7.
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DATE
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..EIGNATURE (df&NER OR
DATE $10 ED
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ATTOTION
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A UILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
YELLO� - IWSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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PINK - OWNER
GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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