20050438.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT r�
CITY OF EDMONDS ZONE NUMBER ; I
C,`i.
CONSTRUCTION PERMIT APPLICATION ADDRESS SUITE/APT#
OWNER NAME/NAME OF BUSINES4
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
Ix W MAILING ADDRESS / LID FEE $
CP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe Approved
rmlt Required
Street Use Permit Req'd
CITY ZIP TELEPHONE?� 7 EXISTING PROPOSED Inspection Required
/ Sidowalk Required
G< I! REQUIRED DEDICATION.____ FT Underground
Wiring regWred
NAME METWlf ..'614F SIZE NO. OF FIXTUR�S PRV REQUIRED
)` �t �• t,r.,.
CRI Permit
µ�r ���i•� fit.' ....::, ,t. NO ❑
C ADDRESS REMA K
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WN/OORESPONSIBLE
FOR EROSION CONTROL/DRAINAGE
CITY ZIP ITELEPHONE
NAME /) CBL N ?' V,
ENG �Q)f G �I
ADDRESS i,(D I e FIRE
C P / TELEPHONE
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STA/TE' LICENSEE NUMBER EXPIRATION DATE CHECK BY
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PROPERTY TAX ACCOUNT PARCEL NO. C %E{1
CS `7.3 Z0 �d v Ex
❑ NEW RESIDENTIAL UMBING MECH AL GT a(VF�
ent connectors required
appli,><nces passing DATE
SHORELINE OR ADBN I INSPECTION
REO'D
vaivel an
❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE installed on 11 hot water
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN RE 0§QP LOT AREA PLANNING
W
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IT:
BOND
POSTED
HEIGHT
) _ PROPOSED
) SETBACKS (FT.)
UR SIDE REAR c7
z
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z
DATE g
❑
GRADING FENCE REPAIR ❑ CYOS ❑ ( X FT) REMARKS
❑
DEMOLISH.TANK TANK ❑ OTHER
y ❑ GARAGE CARPORT L.! ROCKERY RETAINING WALL ❑ FIRE ALARM FIRE LER
0
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
�`" CHECKED BY JTYP761��NSTRUCTIOOCODE OCCUPAN
GROUP
NUMBER NUMBER OF CRITICAL &I !
OF �% _ DWELLING AREAS SPECIAL INSPECTION AR OCCUPAWI
OSTORIES [/ UNITS NUMBER REQUIRED ❑ YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 106118C109 / IRC109 FINAL INSPECTION REQ'D 9
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a
Ul—� t� rLZ VALUATION
$
O 7 /l2 Description FEE Description FEE
Plan Check State Surcharge,
HEAugcE GLAZING % Lor SLOPE % Building Permit City Surcharge
PLKN CH�`E...CJJK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
C BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
s Engr. Review
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr, Inspection
0SEE BACK OF PINK PERMIT FOR MORE INFORMATION
00
`1 '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
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt k
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 9 Landscape Insp. C DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P P• Total Amt. Due
,
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." �`
Recording Fee Receipt #
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 Official 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.
WORKMEN'S 'COMPENSATIO URANCE AND RCW 18.27.
OFPNIALS SIGNA RE DATE -
SIGN E (OWb,frNER O G4 DATE SI ED
(425)
14
4'Ayr 771-0220
RELEA BY DAT
A TION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU
ORIGINAL -FILE YELLOW- INSPECTOR
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD =YOU ARE MAKING 4 COPIES