20050112.pdfDATE RECEIVED PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
NER NAME/NAME OF 13USINESS
PLAT NAME/S U 8 DIVISION NO. LOT NO. LID NO.
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CITY zip TELEPHONE EXISTING — PROPOSED Inspection Rorpilrod E3
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bo wiring required
NAME METER SIZE LINE SIZE NO. OF FIXTU PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME CBL#
COOP ENGINE . ERING REVIEWED BY DATE
ADDRESS
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7 VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER Oq EXPIRATION DATE C D Y ,SEQ'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED PROPOIED ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING if MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FrL)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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ADDITION COMMERCIAL NA IVA NG 2
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PARKING LOT AREA PLANNING REVIEWED BY DATE :I
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GRADING FENCE I I I 1 1-13 /0-5-
REPAIR CYDS . X Fr) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIV7,5EXPLAIN: CHECKED BY TYPE OF CqN57R CTION f (�RF OCCUPANT
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NUMBER NUMBER OF CRITICAL I / r— ( r3) b
0 OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
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0 STORIES UNITS NUMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING.% LOT SLOPE % City Surcharge
Building Permit
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee ts
0��n I Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEU. THIS PERMIT COV
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ul PERMIT APPLICATION: 180 DAYS
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 INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt # P5&&z-
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
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SIGrURE wj(Ew6R. E DA;TE IGNED (425) 0
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I IS UNLAWFULTO USE OR OCCUPYABUI LDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU ORIGJI��- FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/lBC110/lRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4.COPIES.
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