20030874.pdfI
DATE RECEIVED //
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMPAME BUSINESS-,
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MAILING ADDRESS
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CITY
NAME
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NUMBER
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESOP Aplw=.
RW Per. R
Streal L
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underipround
wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESM NO [3 z
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP
TELEPHONE
NAME
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ENGINEERING REVIEWED BY DATE
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CITY ZIP 7ELEPHONE
STATE LICENSE NUMBER EXPIRVION QATE I
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FIRE REVIEWED BY
VARIANCE OR CU
DATE
SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
1 13YEs 13NO $
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PROPERTY TAX ACCOUNT PARCEL NO.
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SEPA REVIEW SIGN AREA HEIGHT
GUMPLETh I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
NEW RESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR GRADING — FENCE
CYDS ( X Fr)
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRO!jT NT UR SIDE REAR
FIRMA* Ar
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REQ`D I PROVIDEQ14w FIL�, REM( OVAL, OR AP
REMARKS
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DEMOLISH jg�"K
oGARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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CHECKED ;7E
NS RU N OCCUPAN
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NUMBER NUM13ER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
SPECIAL INSPEC11ON
REQUIRED [3 YES
Ai�EA OCCUPANT
LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REO'D
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FEE Description
17-10-1-71 "VI 12&16-r Description FEE
Plan Check State Surcharge
HEAT SOURCE
%
LOT SLOPE %
Building Permit
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City Surcharge
PLAN CHECK NO,
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VESTED 13ATE
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
X
Grading
DOOMN (CURSS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIITAPPILICATION: 180 DAYS
IL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR L40RE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
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 NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT CITY
Landscape Insp.
Total Amt. Due
OF ANY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
Receipt #
_J�EREBY 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
APPLICAFION
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 THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or hisfher Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOP,�QDE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt 13 acknowledged In space provided.
WORKMEN'S CSWAN&AT.Ua"S�RA RCW 18.27.
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OFFICIALA,Sl ATURE IDATE
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DATE SIghED 1
SIOED
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63112,1111
(42-1
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771-0220
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RELEASED Bi" I/ ATE
ATTENTION
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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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL EROJECT APPROVAL
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