20050078.pdfr .•
DATE RECEIVED _ I _/ r�)?
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWJE� NAME/NAME OF IIIUSINESS
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CITY
NAME
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C ADDRESS
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CITY
ZIP TELEPHONE
ZIP ITELEPHONE
I I PERMIT EXPIRES Tjp4,
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ZONE PERMIT - -
NUMBER 1I �� L�
JOB SUITE/APT#
ADDRESS A /^
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RApproved
RWW PP Permit Required a [J
Street Use Permit Roq'd o
EXISTING PROPOSED Inspection Required 13
Sidewalk Required E3
REQUIRED DEDICATION Fr Underground
Wiring required O
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
O
YES ❑ NO ❑ Z
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
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eyl1� � 1 b1 yy� ' nl ip/s f . (,v 1 k. 5ery(c V 91 9 �j ENGINEERING REVIEWED BY DATE
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CI ZIP TELEPHONEs
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VWORSE
ARIANCE OR CUV1, C) eECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE C BY POSTED
)I TS 9� Fi.l 71 �) o� (J i
iii SIT S� PRES S
J SEPA RE'� T tA�D'"'PRt?F��ED 'ALL`ONeD EIG PROPOSED
PROPERTY TAX .ACCOUNT PARCEL NO. COMPLETE jPt
V o EXP
❑ NEW RESIDENTIAL 13 ALLOWED / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR r,
❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR F1
CHANGE OF USE Z
PARKING LOT AREA PLANNING REVIEWED BY DATE a
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑
GRADING FENCE REPAIR ❑ CYDS ❑ ( X FT) REMARKS
❑ DEMOLISH TANK ❑ OTHER
GARAGE RETA❑ FIRE
CARPORT ❑ ROCKIERY NING WALL ❑ FIREALARMKLER
(TYPE OF USE, BUSINESS OR A IV XPLAIN:
CHECKED BY TYPE OF ONST TION C D OCCUPANT
i GROUP
NUMBER NUMBER OF CRITICAL
m OF DWELLING AREAS SPECIAL INSPECTION AHA OCCUPANT
/%� LOAD
io STORIES UNITS NUMBER l/ REQUIRED
O
� ❑ YES
DESCRIBE WORK TO BE DONE
REMARKS
I 1
Or
PROGRESS INSPECTIONS PER UBC 108/FINAL If^PECTION REO'D 9
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$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % •�"
Building PermitCity Surcharge
PLAN CHECK NO: �.._� VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
It=
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
a Engr. Review
W PERMIT APPLICATION: 180 DAYS
AL PERMIT LIMIT. 1 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 Fife R@VIEW Plan Chk, Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt a
` ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
S 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 Landscape Ir1Sp. Total Amt. DU@
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
MENEM Recording Fee Receipt N 'O - t2 76)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATIONAPPLICATION 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 acknowlodged In space provided.
WORKMEN'S COMPENSATION SURANCE AND RCW 18.27.
OFFICIALS'SI ` TU DTE
SIGNATU WNER O ENT) DATE SIGNED (425) / �►
4� -w 771'0220 RELEASED BY ATE /J
ATTENtION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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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