20050150.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
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CITY ZIP I TELEPHONE
PERMIT EXPIRES
USE PERMIT
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NUMBER
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO,
LID FEE $
PUBLIC nIGHT OF WAY PER OFFICIAL STREET MAP
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init Required E3
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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STATE LICENSE NUMBER EXPIRATION DATE Type D or L vent c7on"nect ire POSTED
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OYES ONO s
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ROPO 80311621) PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
RESIDENTIAL PLUMBING MECH ALLOWE ' —PROI GBE NDE REAR a
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ADDITION 13 El CHANGE OF USE In additi quire4 D 1E
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REMOD EL 1:1 MULTIFAMILY SIGN REO'D I=" f f %1ftGdffIffPfitbved
REPAIR GRADING __j FENCE siok tank shall be
El CYDS ( � X—M REMAR14 sinstalled on all hot water tanks.
DEMOLISH TANK OTHER
UPC 608
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: Y I TYPE N OCCUPANT
22 CHECKED B GROUP
NUMBER NUMBER OF CRITICAL JAREA OCCUPANT
OF DWELLING AREAS SPECIAL INSPECTION
UNITS N REQUIRED [] YES LOAD
to STORIES R /jU
DESCRIBE WORK TO BE DONE I Q37PA1L tgrAS ro P, KLAcj� REMARKS
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rmLmRESS INSPECTIONS PER UBC 108/IBC109/ IRC109 FINAL INSPECTION REQ'D
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(90K)__4ajj1D _(9,A9 HPJ-r C40VO
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D6scrlption FEE Description FEE
State Surcharge
Plan Check
HEhT dOURCV GLAZING % LOT SLOPE %
Building Permit City Surcharge
Base Fee
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
M
W PERMIT APPLICATION: 180 DAYS
ILI 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
;N 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 #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
!3 DEEMED TO MODIF'4 WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4 Receipt #
Zi Recording Fee
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 Olticial 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.
1�WORKMEN'S COMPENSATI9qr\U RANCE AND RCW 18.27. OFFICIALS fiIGNATURE DATE
SIGNkQTUtj (OWNER OR VEN DATE SIG ED ?
1, (425) 4:11
I /Cg!5 771-0220 &
RELE�
ATTENtION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC1.09 / IBC1 10 / IRC1 10. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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