20030939.pdfDATE RECEIVED
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
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JOB SUITC/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
EQ NAMEINAME OF BUSINESS
pLAT NAME/SUBDIVISION NO. LU I NV. LIU "W.
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FIRE ALARM
CARPORT
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NUMBER
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP ApPrOv9d
RW Porritit Required
Strom Use Permit Rq.d
EXISTING — PROPOSED
Inspection Required 13
Sidowatk Required [3
REQUIRED DEDICATION- FT
Undergmund
Witing required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
f- A 0 131p; -rFST MUST BE
ENGINEERING REVIE?4PD BY BE ACCEF I tu DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADB11
INSPECTION
BOND
REQ'D
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POSTED
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$
SEPA REVIEW
SIGN AREA
HEIG
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR 0
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REO'D I PROVIDED
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M I al GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED 13 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 100/FINAL INSPECTION REO'D
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Description
FEE
Description
FEE
Plan Check
State Surcharge
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HEAT SOURCE LAZNG % LOT SLOPE %
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Building Permit
City Surcharge /5—
PLAN CHECK NO: VESTED DATE
Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: IGO DAYS
PERMIT LIMM I YEAR - 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
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a 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
Landscapeinsp.
Total Amt. Due
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
Receipt #
I HERE13Y 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 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
I ON F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION recalpt Is acknowledged In space provided.
WORK IS COMPENSAT103JNeoFtppCE^RCW 18.27.
FICIALS SIGNA`AJRE
SIG OWNER OR DATE: SIG�ED
142
771-0220
bATE
R LEASED BY
ATTENTION
Off 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 YELLON- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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