20040879.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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NAME
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PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER IL
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED - --
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
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SUITE/APT#
LID NO.
LID FEE S
I ESCP Approved
HW Permit Required
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Street Use Permit Roq'd
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Inspection Required
E3
Sidewalk Required
E3
Underground
Wiring required
[3
PRV REQUIRED
YES 13 NO 0
REMARKS
OWNER/CONIIRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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STATE LICENSE NUMBER E PIRA DATE Y REOQr POSTED
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O.-�_L L) SEPA REVIEW SIGNIA11EA
PROPERTY TAX A NT PARCEL NO. COMPLETE EXKT ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
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COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PMNING REVIEWEI) BY DATE 5
REMODEL El MULTIFAMILY SIGN REQ'D OVIDED q19 (7/(j q IL
GRADING Ei FENCE
REPAIR CYDS I X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CODE OCCUPANT
ri. CHECKED BY I TYPLW CONSTRUCTION
Ec GROUP '13
NUMBER OF CRITICAL I
0 OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
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o STORIES UNITS NUMBER REQUIRED []
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us NUMBER YES
DESCRIBE WORK TO BE DONE
REMARKS 2
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D 2
0
VALUATION
$ %, CL�j I
Description FEE Description FEE
Plan Check State surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
ECK VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= 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
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
CCESORS Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SU
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
It Total Amt. Due
2: FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1111S PERM11 SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE Landscapeinsp.
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2:1 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. Recording Fee Receipt 11 r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
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GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF 1 his application is not a permit until signed by the
THE OWNER. I AGRE!grTO CO I.Y WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL tier Deputy: and Fees are paid, and
TION; AND IN DORO�THF, RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or his/
RELATING TO
IN VIOLATION QeYHVC_ABOR CODE OF THE JSTATE OF WASHINGTON FOR INSPECTION receipt is acknowledged in space providLd.
WORKMEN'S M SATION 0 F1 SIGN RE
J,)ISURANCE A>WRCW 18.27. DATE
SIGN E, OR DATE SIGAD (425)
771-0220 RE _ASFD BY /A E
ATTENTION EXT 1333(1
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU- 0111GINAL - FILE YELLOW /INSPEAR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110- PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 CO- IFS
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