20050335.pdfIFCATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
fRNAME/NAME OF BUSINESS
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CITY
NAME
ADDRESS
CITY
NAME
ZIP TELEPHONE
90) '111 1 W—Y __l) /I
ZIP
TELEPHONE
ADDRESS
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CITY ZIP TELEPHONE
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-STATE LICENSE NUMBER EXPIRATION DATE CHtC6ED BY
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PROPERTY TAX ACCOLINr DARCJEL NO.
of 2
NEW RESIDENTIAL _�WPLUMBING / MECH
ADDITION C] COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL APARTMENT SIGN
REPAIR GRADING FENCE
CYDS ( X Fl)
DEMOLISH TANK OTHER
GARAGE RETAINING WALL RENEWAL
CARPORT ROCKEFIY -
(TYPE OF USE. BUSINESS OR A9TIyITY) EXPkAl
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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PERMIT EXPIRES 05
PERMIT 6( -,o7
NUMBER ab - ::��
SUITEIAPT"
V)s. -
LOT NO. LID NO.
I LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION
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METERI'SW 2UUk4l?RZFj J"90t%FWIXATU�MS
Ipre-siure/relief �alve� an ap
OWNE
TESCP Approved
RW Permit Required
Street Use Permit Req d
Inspection Required
UIRED
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ENGIN EWE Eli 81-1-1 __
I'llype B or L vent connectors required
FIRE gmwuu 9 aPPlIallCeS PH"19DATE W
through unheated spaces. IMC 803.2 %
LL
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
YES 0 NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PURSUANT To UPC (05.2
EXP 411111 ^ I I
SETBACKS(FT.)
LOT COVERA lt7 &%mly ORRIMR SIDE REAR
ALLOWED PR
LIM IT r3NrMS TM B JMDING z
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PARKING LOT AREA I PLANNING REVIEWED BY DATE _j
REO'D I PROVIDED 0-
VALVE (PRV)
CHECKEDBY I TYPE OF CrETRUCTION CODE OCCUPA"
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SPECIAL INSPECTOR JAHE:A OCCUPANT
REQUIRED [:) YES LOAD
REMARKS
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PROGRESS INSPkCTIQqk pq�lg N "PECTION REQ'D a
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE,,;,
BUILDING
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PLAN CHECK NO: VESTED DATE
PLUMBING
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
G&nRCHARGE
cc PERMIT APPLICATION: 180 DAYS
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CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
. SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
Uj IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
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2 EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
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< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 09 INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
x
RECEIX 0
TOTAL AMOUNT DUE
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
_,o —
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 tintil signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Foes are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
rempt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCWV.27
OFFICIA, SIG4ATURE DA;
SIGNATURE (OWN�R)11I�IE�NT TE SIGNED
(425)
771 0220
'RELEASED
E
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771.n921
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
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