20050072.pdfDATE RECEIVED
PERMIT EXPIRES :Z
CITY OF EDMONDS
U S E PERM
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NUMBER 'ZC '05'
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
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PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO.
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
TESCP Approved 13
AW Permit Required 13
Street Use Permit Req 'd 13
inspection Required 13
Sidewalk Required E3
Underground
Wiring required 13
ZIP TELEPHONE
7,-7
NAME
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METER SIZE LIN NO. OF FIXTURES
PRV REQUIRED
13 NO C3
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REMARKS
OWNER/CO NTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
13YES ONO
BOND
POSTED
ST�A LICENSE NUMBER EXPIRATION DATE
46 L 3 1 Wo
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SEPA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED I PROPOSED
PROPERTY TAX A CCOUNT PARCEL NO.
2 2, 7,*
NEW RESIDENTIAL PLUMBING M . ECH
COMPLIANCE OR
E] ADDITION a4MMERCIAL CHANGE OF USE
ZREMODEL El MULTIFAMILY E] SIGN
LOT COVERAGE
ALLOWED. PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT QRSIDE REAR
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PARKING
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LOT AREA
PLANNING REVIEWED BY DATE
REPAIR GRADING FENCE
11 CYDS 1:1 ( X FT)
REMARKS
DEMOLISH TANK E:i OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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CHECKED BY
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OCCUPANT
GROUP
NbMBEF1 NUMBJ�14% CRITICAL
OF DWELLING AREAS
STORIES-- I UNITS I Ald I NUMBER
DESCRIBE WORK TO BE DONE
SPECIAL INSPECTION jfi�REA
REQUIRED [] YES
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/171NAL INSPECTION REO'D
-3
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK -NO: VESTED DATE
Plumbing
aMechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 INDEMNIF4 DEFEND AND HOLD.HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL 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
01 NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
x
Recording Fee
Receipt #
I 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 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
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION�URANCE AND RCW 18.27.
OFFICIALS SIGNATURE E
�ATP (OWNER 0 E -NFD
(425)
qDA
771-0220
RELEAS�D BY DATE
ATTEWIbA
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
I 1"h1w-t 6-h/ Lt5
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL�- YELLOWANSPE4OR
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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RECORD OF INSPECTIONS