20040292A.pdfIII
DATE RECEIVED,
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER
EXPIR)TION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
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PLUMBING / MECH
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ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
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DEMOLISH
1-1 TANK
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oGARAGE
CARPORT
RETAINING WALL
17 ROCKERY
FIRE SPRINKLER
1:3 FIRE ALARM
(TYPE OF USE, BUSINESS_PR ACTIVITY) EXPLAIN:
PERMIT EXPIRES
USE PERMIT
'0" NUMBER
JOB
ADDRESS
SUITE/APT#
PLAT NAME"SUDDIVISION NO.
LOT NO
LID NO.
LID FEE $
PUBLIC HiGH1 OF WAY PER OFFICIAL STREET MAP
JESCP Approved 13
FjW Permit Roqui(ed E3
Street use Permit Pori'd E3
EXISTING PROPOSED
inspection Required Q
S,clowalk Requited E3
REQUIRED DEDICATION Fr
underground
E3
Wiring required
METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES 11 NO 1-1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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GINEERING REVIEWED B DATE
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IRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
EIYES ONO i $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FF.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING
REO'D I PROVIDED
REMARKS
LOT AREA I PLANNING REVIEWED BY
7-1 CHECKED BY I TYPE OF CON
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4�V, DWELLING AREAS SPECIAL INSPECTION
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0 STORIES 4C4 s NUMBSER REQUIRED
I DESCRIBE WORK TO BE DONE
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D F3
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VALUATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
—7*%
City Surcharge
PLAN CHECMK .
VESTED DATE
Plumbing
Base Fee
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
2
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
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PERMIT APPLICATION: 180 DAYS
Engr. Inspection
CL
PERMIT LIMIT.* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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Fire Review
Plan Chk. Deposit
W 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 III
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALL NOT BE
REQUIREMENT
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt # 4�/ 71
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
This application is not a perinif until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/tier 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 C7_Vj_tftTION IPSURANCE AND RCW 18,27.
OFFI(?,IALS SIGNATURE DATE
SIGNATU (0 _R AG D SIGNED
(425)
771-0220
REL ASED DA E
ATTENTION
EXT 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 YELLOVi-INSPE. OR
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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