20050305.pdfto
U USE
ZONE PERMIT
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION JOB SUITE APT n
F70WTR NAME NAME OF 7SINESS ADDRESS //V/) _5vtA41-1*_
LEGAL DESCRIPTION CHECK SUBDIVISION NO LID r4O
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0 PU LI C TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ZIP
090
ADDRESS
NUMBER
RW Permit Required
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EXISTING REOUIIIED DEDICATION
Street Use Permit Req'd
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Inspection Required
1:1
PROPOSED
Sidewalk Required
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REMARKS
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PHONE NUMBER
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ADDRESS
NO. OF FIXTURES
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CITY ZIP TELEPHONE NUMBER
REMARKS
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STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA SEPA REVIEW ADB NO
riD ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - inbi,620411 easements SHORELINE
EXP
VARIANCE OR CU PLANNING, REVIEW BY DATE
SETBACKS — FEET HEIGHT ILOT COVERAGE
FRONT SIDE REAR I
P roperty A.
Tax Account
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NUMBER OF STORIES
NUMBER OF
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SPECIAL INSPECTOR AMEA OCCUPANCY
REQUIRED GROUP
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REMARKS
PROGRESS INSPECTIONS PER UBC 305
IFINALINSPECTION REQUIRED
01AVv) —T— , PLAN CHECK FEE
(6 BUILDING
HEAT SOURCE: GLAZI
PLUMBING
Plan Check No. Its— MECHANICAL
6.
This Permit covers work to be done on private property ONLY. GRADINGIFILL
.Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days STORM DRAINAGE FEE
Permit Limit: I Year m Provided Work Is Started Within 180 Days
"Applicant, I on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
successors in interest, agrees to indemnity, defend and hold
harmless. the City of Edmonds, Washington. its officials,
employees, and agents from any and all claims for damages of
POSIT
whatever nature, arising directly or indirectly 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
0 TOTAL AMOUNT DUE
nor limit in any way the City's ability to enforce any.ordinance
provision."
I hereby acknowledge that I have read this application; that the ATTENTION
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construct lon;'and in doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY THE
Code of the State of Wc3soington relating to Workmen's Compensa- WORK NOTED
tion Insurance. INSPECTION
DEPARTMENT
R APENT) DATE SIGNED
CITY OF.
EDMONDS
CALL FOR
ATTENTION INSPECTION,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, USC
CHAPTER 3.
102-87
OCCUPANT
LOAD
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE UA It
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ELEASED BY
ORIUI Ak — FdU YELLO I W — Insoector
PINK — Owner GOLD — Assessor
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INSPECT OR DATE APPROV ED
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Gas Piping .............
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FRAMING ......... .......
SHEETROCK NAILING
SPECIAL I NSPECTION ...
FINAL APPROVAL
FOR OCCUPANCY ..... .
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