20050173.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP TELEPHONE
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ADDRESS
CITY ZIP TELEPHONE
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L t-- PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOBSUITE/ T#
ADDRESS
PLAT NAME; SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved a
RW Permit Req uitod LLg..11
Street use Permit Rq'd
EXISTING PROPOSED Inspection Required Q
Sidewalk Required. Q
C REQUIRED DEDICATION UndeWidnpr quired Q
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES ❑ NO =
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REMARKS i
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Y
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CITY ZIP TELEPHONE is
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STAT ICENSE NUMBER EXPIT11UN ATE CHECKED BY V/
IANCE OR SH ELINE OR ADEN INSPECTION BOND
�1 13(�� / REO'D POSTED
V.o ZS2 i G ❑YES ONO g
SEPA REVIEW SIGN AREA HEIGHT
'ROPERTY JAX ACCOUNT
0) t7 Q3 q925``PARRC�CEL NO. % COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
❑ NEW RESIDENTIALLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
Z
13ADDITION COMMERCIAL ❑ _
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
REUOVNLWOC ❑ MULTIFAMILY SIGN ❑ REO'D PROVIDED
1:1 REPAIR ❑ GRADING CYDS ❑ FENCE
( X FT) REMARKS
DEMOLISI TANK 11 OTHER
GARAGE ❑ CARPORT ❑ ROCKERY RETAINING WALL ❑ FIRE ALARM FIRE LER
(TYPE OF USE, BUSIMESS OR A0jlVn 0 EXPV4N: `
_ CHECKED BY TYPE OFC STRUCTION CODE OCCUPANT
GROUP
NUMBER NUMBER. OF V � CRIT1640
OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
STORIES UNITS NUMBER REQUIRED LOAD
YES
ESCRIBE WORK TO BE NE A
'` REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109ifIRC109FINAL INSPECTION REO'D 9
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do no.\ _.
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jTll' GXr4o lycof moi-¢ Description FEE Description FEE
Plan Check X State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NQr, VESTED pnTE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION,
QEngr, Review
W PERMIT APPLICATION: 180 DAYS
d 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 Fire Review r j' Plan Chk. Deposit %
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Q EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection e" Receipt #
` ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 65-1 A
S FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
�] DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due 5e
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
_ Recording Fee Receipt #
I HEREBY ACKNOWLE E THAT I AVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT AND THAT I M THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I EE TO COMP L WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION: AND IN 01 THE WORK THORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VI O 0 T E DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WO MEN' CO ATION IN NCE AND RCW 18.27.
FFI SIG URE DATE
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SIGMeow R DATE SIGNED _ (425) •� %a/C� e
771-0220 R L IASED BY (� TE
ATTE IO EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL [111(111 �INSPECTION HAS BEEN MADE ANDAPPROVALORACERTIFICATEOFOCCU-ORIGI L- ILE YELL -INSPECTOR
PANCY HAS BEEN GRANTED, UBC109 / IBC110/ IRC110. PINK . WNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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