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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING AD -DRESS
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CITY ZIP ITELFPHONE
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STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
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'ROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL
COMPLIANCE OR
ADDITION 8000MMERCiAL CHANGE OF USE
REMODEL MULTIFAMILY E] SIGN
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REPAIR CYDS FT)
0 DEMOLISH TANK OTHER
GARAGE RETAJNINGWALIL F RE SPRINKLER
CARPO 1:3 ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVrM EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW Par"t Required
Street Use Poffnh ReWd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground C3
METER SIZE LINE SIZE NO. OF FIXTURES
PRV RE UIRED
REMARKS
Y E s C033 NO 13
OWNER/CONTRACTOR RESPONSIBI. FOR EROSION CONTROLIDRAINAGE
BY DATE
FIRE REVIEWED BY
DATE W
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VARIANCE OR CU
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ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
PROPOSED SET13ACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
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REMARKS �
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CHECKED BY ITYPE j�RMTR CTION COME_ OCCUPANT
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SPECIAL INSPECTION EA OCCUPANT
REQUIRED [3 YES LOAD
REMARKS
11PROGRESS INSPECTIONS PER UBC 1101111MINAL INSPECTION REQ'D
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, DRIVEWAVS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMrT APPUCATION: 180 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFX 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.-
�HEREUY 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-
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
WORKMEN'S COMPEN?kT2WffWQ.,MNCE AND RCW 18.27.
SIGNATURE (O!!!!:��
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,aj,4WV 1;7�� I DATE SIGNED,,
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chill. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
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1,425
771-0220
EXT 1333
APPLICATION APPROVAL'
This application Is not a permit Until signed by the
Building Official or his/her Deputy: and Nos are paid, and
recelpt Is acknowledged In space provided.
OMM DATE
REL SED BY
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L�� 4& P U
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL-FLE YELLOW-INSPEA
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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USE PERMIT
ZONE NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
t5FN P1 AT NAME/SUBDMSION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Penni
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CITY- EXISTING — PROPOSED Inspection Required
ZIP TELEPHONE Sidwalk Required
REQUIRED DEDICATION— FT underground
5�>M,v Ps W� Lj:,!5--7/ Wiring required cl
NAME METER SIZE 0. OF FIXTURES PAV REQUIRED
_PINE SIZE7 YES 13 NO 13
7AOM A G
E ADDRESS REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE A
NAME CBL#
ADDRESS I Lu P_ ENGINEERING REVIEWED BY DATE
/9e06)7 QI(14 Ilt f*Ae oes'' DATE
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FIRE REVIEWED BY w
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ZIP TELEeHONE /A V6
y4ey ! VARIANCE OR CU SHORELINE OR ADBN 'INSPECTION BOND
STATE 110ENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
-VIL ..... WA~ 13YES NO S
V6
7 vo SEPA REVIEW SIGN AREA HEIGHT
OPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
:47 at 2-e V110, A
EXP
LOT COVERAGE REQUIRED. SETBACKS (Fr.) PROPOSED SET13ACKS (Fr.)
EYNEW RESIDENTIAL G31*'PwMelivi 10 ALLOWED PROPOSED FRONT SIDE REAR FRONT LIASIDE REAR
COMPLIANCEOR
0 ADDITION COMMERCIAL 1-1 CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
4 REMODEL MULTIFAMILY 1:1 SIGN REOrD PROVIDED 06
RERMR GRADING CYDS 0 FENCE X V
FT) REMARKS
L DEMOLISH OTHER kisa6 a
0 TANK
GARAGE RETAININGWALL 0 FIRE SPRINKLER
'CARPORT [:]
ROCKERY FIRE ALARM
0 A EXPLAIN: TYPE =0
(!YPE OFJJSE, BUSINESS
CHECKED BY N CM OCCUPANT
rZAN—r GROUP
NUMBER j.NUMBER OF ITICAL I
.1. t . 1-.PR SPECIAL INSPECTION REA OCCUPANT
OF JU WELLING AREAS �1/14 A LOAD
SAES N, NITS_ NUMBER-- REQUIRED
-'-DEWRM WORK TO BE E
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
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Description FEE Description FEE_
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT S�RPE % Building Permit City Surcharge
'n pv,�: 1 1.,/ & fj L19 -- -
PLAN CHIECK NO: /I , I VESTED DAtE Plumbing
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EXI AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical /U
THIS P I
Ill: 13E E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
:3 DOIIIIAIN (CUIRBS, SIDEWALKS, DRIVIEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
Engr. Review
PERMITAPPLICATION. 1150DAYS
ERMIT-UMM I YEAR - PROVIDED WORK IS STAFaED WMI11WIN DAYS Eng, In Ion
SEE BACK OF PINK PERMIT FPR MORE INFORMATI56ti
Fire Review, Plan Chk. Deposit
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND.AUCCESCIRS
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE -11 1 —1.,
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND, Fire Inspeclion' Receipt #
II ALL CLAIMS'FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR thIDIRECTLY
FROM THE ISSUANCE OF THIS PERMrT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelrisp. Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Receipt #
Recording Fee
1 HEREBY ACKNOWLEDdE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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 pemh until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: aid Fees are paid, and
IN VIOLATION Ok THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowled.ged In space provided.
WORKMENS COM - PE - NSAT CE AND RCW 18.27. DATE
2= OF L GNAkT~
SIGNATURE (OW=15h� E SIGNED (42
DAT
_7-11 0 W�4
0 -0220
771 RELSEASED 8
AMNTf0N' M 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 - INSPE&OR
CAIE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04101 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING