20050013.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSJNESS
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CITY ZIP T!L�PHONE
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CITY ZIP TELEPHONE
NAME CBIL N
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ADDRESS
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STATE LICENSE NUMBER EXPIRATION, DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL PLUMBING if MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR 0 CYDS El ( x FT)
OTHER
DEMOLISH TANK M
GARAGE RETAININGWALL ED FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
5
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES -UNITS NUMBER
DESCBIBE WORK TO BE DQNE e I-e-c'— Ly 41j,
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PLAN t:HECK NO: 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
SEPARATE PERMISSION.
PERMIT APPUCATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
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SIGNATOE (OWNER OlktEIVA DATf, SIG)ED
PERMIT EXPIRES
USE
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NUMBER,
JOB
ADDRESSg
SUITEIAPT#
PLAI NAME/SUBDIVISION NO.
7
OT NO.
LID NO.
LID FEE $
PUBLIC RIC14T OF WAY PERoFFICIAL STREET MAP
TESCP Approved
RW Permit Roquired
C3
CI
street use Permit Rani'd
0
EXISTING — PROPOSED
inspection Required
Sidewalk Required
13
[3
REQUIRED DEDICATION— Ft
Underground
Widog required
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
FrRV REQUIRED
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YES E3 NO E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
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ENGINEERING REVIEWED BY ff, �: P) DATE
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FIRE REVIEWED BY DATE LU
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION 1. BOND
REO'D POSTED
OYES ONO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED , PROPOSED
LOT COVERAGE I REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (IFT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREJ PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
REMARKS
Vent Cu,,;-7AtVS-
through unheated
GROUP
SPECIAL INS PECTION"
JAREA
OCCUPANI
REQUIRED [] YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC loe/IBC109/IRC109 FINAL INSPECTION REO'D
9
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VALUATION
,Rescription FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknovirledged in space provided.
OFytglALS SIGNATURE DATE
(425)
771--0220 'RELIEME6 Bq' /DATE
ATTENTION 41 EXT 1333 -------
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE ANb APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03. PRESS HARD -YOU ARE MAKING 4 COPIES
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