20050039.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
PERMIT EXPIRES
UbE PERMIT
ZONE /�-7 -
NUMBER 14,()
JOB
SUjE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
TESCP Approved
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PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
Rw Permit Required
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Stre0i Use Permit Roq'd
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EXISTING - PROPOSED
Inspection Required
Sidewalk Required
El
13
REQUIRED DEDICATION-
FT
Underground
wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13
2;
REMARKS
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OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CA
1(,t ro C �crd-(? )d- 1 DATE
ENGINEERING REVIEWED BY
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ADDRESS
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FIRE REVIEWED BY DATE W
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,CITY ZIP TELEPHONE
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXP RATION DATE I (MY REO'D POSTED
EIYEs EINOIS
PD i SEPA RE SIGN AREA HEIGHT
PROPOSED
Qj PROPERTY TAX ACCOUNT L NO. COMPLETE E PT ALLOWED I PROPOSED ALLOWED
PT
us EXP
_j 0 0 Hu� 01 csln_� 00 Q -_ ' -*bQPIRED SETBAC
LOT COVERAGE R KS (FT.) PROPOSED SETBACKS (FT)
NEW �rRESIDENTIAL 1:1 PLUMBING MECH ALLOWED PROPOSED FRON,< REAR FRONT UR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNI REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING El FENCE
13 REPAIR El CYDS ( X� FT) REMARKS
DEMOLISH 1:1 TANK OTHER
GARAGE -1 RETAINING WALL FIRE SPRINKLER
z CARPORT 0 ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: 0-) OCCUPANT
r CHECKED BY GROUP
'JUMBER OF CRITICAL OCCUPANT
OF )WELLING AREAS SPECIAL INSPECTION AREA
_7EUNITS YE LOAD
NUMBER
ci STORIES NUMBER REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HE SOURCE LAZING % LOT SL?PE %
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Building Permit
(00 City Surcharge
6—
ECK NO VESTED DATE
Plumbing
Base Fee
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 (CURDS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERM'ISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CIT-Y OF
X EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTiY OR INDIRECTLY
OF THIS PERMIT SHALL NOT HE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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Recording Fee
Receipt # I
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION 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 I s not a permit until signed by the
Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE �A' F THE STATE OF WASHINGTON RELATING To
Building Official or h I s/her Deputy; and
FOR INSPECTION receipt is Icknowledged in space provided.
WORKMEN'S COMPE CE AND FICW 18.27.
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771-0220
RELEASED BY DATr
AftENTION
Off 1333
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ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBcIo9/IBC110/IRC110-
PINK -OWNER - GOLO-ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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