20050011.pdfDATE RECEIV
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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NAME CBL N
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PERMIT EXPIRE S .�Z
USE PERMIT
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J013 SUITE/API #
ADDRESS 7�k�'e 6")
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
I ESCP Approved E3
PUBLIC RIG117 OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Roq 'd
EXISTING - PROPOSED Inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION- FT underground
Wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO C3
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REMARKS z
OWNERICONT AlMa, 5
jrl�pe B or L vent connectors required IJU
Ion fluel-burning appliances PASNIH9
BY I DATE
ADDRESS o7
FIRE REVIEWED BY DATE
Cl ZIPU TELEPHONE
VARIANCE 08 CU SHORELINE Oil ADIIII INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE COCK Y REO'D POSTED
SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
NEW 6(RESiDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R,SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA rNNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D I PROVIDED
13 REPAIR E] GRADING DS FENCE FT) REMARKS
CY x
DEMOLISH, El TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY ITYPE E OCCUPANT
GROUP
NUMBER OF CRITICAL
I !�j CRITIC' OCCUPANT
OF IWELLING FAREAS SPECIAL INSPECTION REA
I UM 2 ------ LOAD
STORIES NUMBER REQUIRED [] YES
NUMBER
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/ ISC109/IRC109 FINAL INSPECTION REO'D -
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VALUATION
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Description
FEE Description FEE
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Plan Check
State Surcharge
HEAT go,'T MJG LOT SLOPE %
Building Permit
City Surcharge AE
PLAWICHEICK NO: VESTED DATE
FPLLAC0
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
Grading
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
::I
t: SEPARATE PERMISSION.
Engr. Review
2
PERMIT APPILICATION: 180DAYS
CL PERMIT LIMIT. I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N INTEREST, TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Plan Chk. Deposit
AGREES
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION!
Recording Fee
Receipt #
.1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPL'ICATION 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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
/"� recelp)js acknowledged In space provided.
WORKMEN'S COMPENSAT12��SURANCE AND RCW 18.27.
ATU DATE
10Y6 RE
SIG7NE (OWNER 0 GE T)! DATEJIGNED
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A#ENTION
Off 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/[RC110.
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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