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�PERMIT EXPIRES
CITY OF EDMONDS
U PERMIT
ZONE NUMBER ge3-
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
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OWNER NAMEINAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO, LOT NO. LID NO.
15 MAILING ADDRESS
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFIC"IAL STREET MAP Per N Required
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uas Permit Raq'd
CITY ZIP TELEPHONE
Street
EXISTING - PROPOSED Inspection Required
Sidewalk Required
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REQUIRED DEDICATION- FT ndefground
iring required 13
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YEs[3 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME _jCBL#
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ENGINEERING REVIEWED BY DATE
AD RESS
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CITY zip TELEPHONE
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR A0B# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DA�T� BY
REO'D POSTED
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SEPA REVIEW SIGN AREA' HEIGHT
PROPERTY TAX ACCOUNT eARCEL,NO.
COMPI.ETE EXEMPT ALLOWED PROPOSED . ALLOWED PROPOSED
FIRE MARSH" L
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EXP
NEW RESIDENTIAL PLUMBING MECH
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LOTCOVERAGE W11%)IME1111dWSM9141i fjffT
ALLOWED PROjfV 1�.fff r fNAYIDE REAR
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COMPLIANCE OR
ADDITION COMMERCIAL 0 CHANGE OF USE
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0 REMODEL 0 MULTIFAMILY SIGN
PARKING LOT AREA PLANNING REVIEW9D,SY DATE
REO'D PROVIDED
GRADING FENCE
El REPAIR CYDS ( X FT)
REMARKS
OTHER
DEMOLISH TANK
GARAGE -1 RETAININGWALL F RE SPRINKLER
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CARPORT ROCKERY FiRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVrM EXPLAIN:
CHECKED BY OCCUPANT/,
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
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SPECIAL INSPECTION JAR EA OCCUPANT
STORIES UNITS NUMBER 40
REQUIRED Ej YES LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
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PROGRESS INSPECnONS PER USC 1108/FINAL INSPECTION REG-0
VALUATION
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Description "FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE LAZING % LOT SLOPE %
00ft @ ilk
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Building Permit City Surcharge
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PLAN CHECK NO: VESTED DATE
Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURIIS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
:3
L_ SEPARATE PERMISSION.
Engr. Review
PERMI'TAPPILICATION: ISO DAYS
is. PERMIT UMM 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
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
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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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 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 his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATIOhLWSURANCE AND RCW 18.27.
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SIGNATURE (OWNER 0 GENT) AT SIGNED
(425)
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771-0220 hii'LEA f
S E Dtflf DAY
ATTENTION7"
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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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM
TO:
DATE:
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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