20040044 (2).pdfDATE RECE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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SIGN
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GRADING
1:1 CYDS
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7 TANK
OTHER
EiGARAGE
CARPORT
RETAINING WALL
1:1 ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF OWE AREAS
STORIES UNI1 NUMBER
DESCRIBE WORK TO BE DONE ii I -
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
I PERMIT EXPIRES
PERMIT -t
NUMBER 1�014 ��LN
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
13
RW Permit Required
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Street Use Permit Rnq'd
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Inspection Required
13
Sidewalk Required
13
Underground
Wiring required
PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONT13OLIDRAINAGE a
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REQUIRED SETBACKS (FT.)
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ALLOWED PROPOSED
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GAECKED BY TYPE _Q�ONSTRUCTIC% rCq E 1 0 =CUPANT
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SPECIAL INSPE;TION JAREA OCCU
REQUIRED YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPE
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VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
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LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
City Surcharge
PLAN CHECK NO,
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
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UJI PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Plan Chk. Deposit
LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTtY OR INDIRECTLY
FROM THE ISSUANCE or THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Fhis application is not a permit until signed by the
TION; AND IN DOING TIIE'��HORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building ollicial or his/her Deputy. and Fees are paid, and
IN VIOLATION OF OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
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THE -AG 588
WORKMEN'S COMPENSAtTrN INIS E AND ROW 18.27.
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SIGNATURE (OWNER O�A DATE SIGNED (425) /f OAT E
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771-0220� RFtFXSFD'BY OAT
ATTEN ON' E)ff 133i,, I 11�
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 - YELLCtV-INSPECTOd
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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