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1W 2 PERMIT EXPIRES 1�
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USE PERMIT --7,
CITY OF EDMONDSQ../ ZONE to - 0114� b%2
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CONSTRUCTION PERMIT APPLICATION ADDRESS (51ff )
0 NER E OF 8 INESS
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MAILING AD RIESS LID FEE S
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0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Portnit Required 13
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CITY ZIP T EPHONE EXISTING - PROPOSED Inspect on Ron od E3
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OWNER/CONTRAC1OR RESPONSIBLE FOR EROSION CONTROODRAINAGE
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STATE LICENO. ILIMARIFIj EXPIRATION DATE CHECKED BY REO'D POSTED
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SEPA REVIEW SIGN AREA ROPOSED
< PROPERTY TAX� �A NT PARCEL. NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED P
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
1:1 NEW E2/RESIDENTIAL PLUM13ING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SqE REA
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EMODEL MULTIFAMILY SIGN REQ'D I PROVIDED
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REPAIR GRADING FENCE 1_�,
CYDS X FT) REMARKS
DEMOLISH TANK OTHER
oGARAGE RETAINING WALL FIRE SANKLER
CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINV)q OR.ACTIVITYA EX
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rx j CHECKED BY CONt�M J� OCCUPANT
0 J) I M A C 44 GROUP
NUMBER NUMBER OF CRITICALO V NM 17W
AREAS Jill IAL INSPECTION
OF DWELLING SPEC AREA OCCUPANT
0 STORIES UNITS It I -NUMBER REQUIRED YES LOAD
DESCRIBE WORK TO BE DONE I �z 13 0
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D,
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k4e�se VALUATION
$41
Description FEE Description FEE
Plan Check State Surcharge 4r5D
HEAT SOURCE GLAZING % 'LOT SLOPE %
Building Permit V7 City Surcharge
CHECK NO: Ctj � I �� 5 - VESTED DATE Plumbing Base Fee I
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BE14ALF Or HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit 64 Cf
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
M ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT BE
Landscapelnsp- Total Amt. Due 0
!3 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CIrY`G ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
ml Recording Fee Receipt #
11 HEREBY ACKNOWLEDGE THAT I IIAVE READ Tills APPLICATION; THAT THE INFORMATION :aL
GIVEN IS CORRECT. AND THAT I AM TIIE OWNER. On THE DULY AUTHORIZED AGENTOF APPLICATION APPROVAL
TIIE OWNER. I AGREE TO COMPLY WITI11 CITY AND STATE LAWS REGULATING CONSTRUC- CALL I his application is not a permil until signed by the
TION; AND IN DOING THE WORK AUTHonizc-D THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or hisitier Deputy: and Foes are paid, and
IN VIOI�A�f TIIE LABOR CODE OF 1111E STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORK4,V'S COMT`fNSATION INSURANCE AND RCW 10.21, DATE
OFFICIALS SIGNATURE
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ATTENTION Off 1333�
IT IS UNLAWFUL TO USE Oil OCCUPY A BUILDING Oil STIIUCTUIIE UNTIL.
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A FINAL INSPECTION HAS BEEN MADE AND APP11OVAL Oil A CEnTIFI- 0jjI(',IfjAj F111 Y111CAV INSPFCTOtl
CATE OF OCCUPANCY HAS BEEN GnANTED. U13C SECTION 109 PINK OWNER 60tO WiliLSSOII
09/03 PRESS HARD -YOU ARE MAKING 4 COPI S
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NOTICE:. - IF THE DOCUMENT IN THIS FIR AME IS LESS CLEAR THAN THIS NOTICE
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