20040938.pdf0
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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CITY ZIP I TELEPHONE
NAME
LEGAC'.c* ROOFING, iilqdL
ADDRESS 19380 N.E. Union HM Road
CITY
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(4i5) 868
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STATE LICENSE NUMBER
EXPIRATION DATFE]
C)fCKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
2-`7
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1:1
NEW
RESIDENTIAL
PLUMBING / MECH
1 :1
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
El
MULTIFAMILY
SIGN
REPAIR
1:1
GRADING rYDq
1:1
FENCE
1 X FO
DEMOLISH
TANK
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GARAGE
CARPORT
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RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINEqS.PR ACTIVITY) FXPLAIN:
OF
NUMBER NUM13EA CRITICAL
OF DWELLING AREAS
UNITS NUMBER
o STORIES I I i I
1 DESCRIBE WORK TO BE DONE
1/,/ 1 1 PERMIT EXPIRES --2 / ,
USE PERMIT
ZONE NUMBER,
JOB U TEIAPT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Roq'd
EXISTING - PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 N 0 E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE ORADIII I INSPECTION BONI)
REQ'D POSTED
DYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (F7) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED I
REMARKS
CHECKED BY
I TYPE,1AF NST CTION
CODE
OCCUPANT
GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED [] YES
JAREA�
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG-D
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HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
.j SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
0. PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
110 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. 'E OMPLY WITH CIP(AND STATE LAWS REGULATING CONSTRUC-
I AGRE
TION; AND IN DOINGIHEWK�A THOR. REBY, NO PERSON WILL BE EMPLOYED
IN VIOLATVN,, T E IrTloi�IETHETATE OF WASHINGTON RELATING TO
E E O�
TPT I I A
WnAKMF?J r r S I NS NCE AND RCW 18.27.
DATE IGNED
VALUATION
$ /4 g, � �z
Description FEE Description FEE
Plan Check State Surcharge __;� 5-0
Building Permit City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt N
Amt. Due
Landscapeinsp.
Total
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
FOR INSPECTION
receipt is acknowledged in space provided.
0 LS SIGN URE DATE
(425)
ATTENtION EXT 1333
IT IS UNLA UL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I -
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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