20040325.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OJER NAME/NAME OF BU EBB
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CITY TELEPHONE
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STATE tICENSE NUMBER %,-
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0 NEW
0 RESIDENTIAL
0 ADDITION
OMMERCIAL
0 REMODEL
ol MULTIFAMILY
0 REPAIR
0 GRADING CYDS
0 DEMOLISH
0 TANK
GARAGE
0 CARPOFrr
0 RETAININGWALL
ROCKERY
S"s
(TYPE OF USE, BUSINE OR ACTIVITY1 EXPLAIN:
INUMBER OF
NUMBER
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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0 PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
J,n�SIGN
IFENCE
3 ( X FT)
[3 OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER��&//-
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE
IESCP
1
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW , R=..
Street Use permit Req'd
EXISTING — PROPOSED-- inspection
Required
SideWalk Requif6d
REQUIRED DEDICATION— FT
Undwgrowd
Wiring required 13
METER SIZE
LINE SIZE
IES
PRV REQUIRED
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YES NO 13
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REMARKS
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OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
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0
FIRE REVIEWED BY DATE
0
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VARIANCE OR CLI
SHORELINE OR AOB# j INSYECTION
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POSTED
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SEPA REVIEW
— EXEMPT
COMPLETE
SIGN AREV
ALLOWED PROPOSED ALLOWED
HEIGHT
PROPOSEJD
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EXP
LOT COVERAGE
REQUIRED SETBACKS (FT): �PROPOSED
SETBACKS (FT)
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ALLOWED PROPOSED
FRONT SIDE REAR FRO,NT
L/RSIDE REAR
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PARKING LOT`7�
REMEWED16 DATE
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REQ`D
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REMARKS
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SPECLALINSPECTION JAREA.
OCCUPANT
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REQUIRED [3YES
LOAD
0
REMARKS
PROGRESS INSPECVIONS PER UBC 1081FINAL INSPECTION REG-0
VALUATION
Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
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LOT SLOPE %
Building Permit
City Surcharge
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Plumbing
Base Fee
PLAN CHECK NO:
VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
I DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION-
Grading
Engr. Review
I
PERMIT APPLICATION: IGODAYS
L PERMIT UPAM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
SHIN ON ITQ OFFICIALS EMPLOYEES AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
EDMUNU5,
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
DEEMED
NOR LIMIT IN ANY WAY THE CITYS ABILUY TO ENFORCE ANY ORDINANCE PROVISION."
Fee
Receipt #
V,0,,�gr
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Recording
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
Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERS ON WILL BE EMPLOYED
IN VIOLATION OF 'THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
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SIG URE (OW EP1%
DATE SI NED
1A
t-1251
771-0220
P1,ALS
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AITE TION 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 YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU A=
KIN 4 PIES