20040203.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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NEW
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ADDITION
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DEMOLISH
TANK
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OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
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FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE PERMIT
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ADDRESS � I :�) _6
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGH1 OF WAY PER OFFICIAL STREET MAP
TESCP Approved
HW Permit Roquirod
13
Q
street use Ponnit 13oq'd
Q
EXISTING — PROPOSED
inspection Required
13
Sidawalk Floquirod
E3
REQUIRED DEDICATION— FT
Undeigrotind
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
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YES 11 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
ENGINEERI
FIRE REVIEWED BY
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DATE
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PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
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FRONT LJR SIDE REAR
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REO'D I PROVIDED
REMARKS
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NUMBER NUMBER OF
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AREAS
SPECIAL INSPECTION JAREA OCCUPANT
STORIES UNITS
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fREMARKS
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT. SOU GLAZING % LOTSLOPE %
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Building Permit
city surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ir PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
hk. Deposit
Plan C 77
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W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENIS FROM ANY AND
Fire Inspection
Receipt # �Ml
a: ALL CLAIMS FOR DAMAGES OFWIIATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
It
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
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Landscape Insp.
Total Amt. Due
0/
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABIL11Y TO ENFORCE ANY ORDINANCE P11OVISION
Recording Fee
Receipt # x
1 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
I his application is not a permit until signed by the
110N. AND IN DOING THE W013K AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/lie, Deputy. and Fees are paid, and
ieceipt is acknowiLdged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27,
OFFICIAI IGNArURF PATE
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R (OWN - R, Ab,�T) DATE SIGNED
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771-0220
'AFL �LIAY DATE
ATTENTION
EXT 1333
// / ;/ /) �/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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Lill l. F-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELL04 - INSXCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
09;03 PRESS HARD -YOU ARE MAKING 4 COPIES
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