20050660.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
M711
CITY zl� TELEPHONE
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NAME
ADDRESS
CITY
NAME
ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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13 NEW
VRESIDENTIAL _____yPLUMBING/MECH
ADDITION
COMPLIANCE OR
COMMERCIAL CHANGE OF USE
REMODEL
MULTIFAMILY SIGN
Fl REPAIR
GRADING
CYDR
FENCE
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DEMOLISH
TANK
OTHER
GARAGE
RETAININGWALL
0
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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USE
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ADDRESS
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PERMIT EXPIRES
PERMIT
NUMBER (;�/�,L
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SUITE/APT#
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
13
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;11r_o 17, �l 40 (RU
.Iteg SUCCSS Wiring raquired
REQUIRE17 DEDICATI&NIi'U 1) fl C =8032
METER SIZE LINE SIZE TNO. OF FIXTURES PRV REQUIRE 0
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REMARKS
]In addition to the required
p pres
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ressurelrelief valve, an approved
e EJ:Tpansion tankshall be
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UPC 60.9
FIRE REVIEWED BY DATE Lu z
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GAS PIPE M
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0
VARIANCE 't*E*4Edah1tb)E* ECWYI I isl BOND M
-MAYITS SH POSTED
111E _E 0 $
SEPA REVIEW HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED
EXP
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LOT COVERAGE REQUIRED SETBACKS JFT.) PROPOSED SETBACKS (Fr.) M
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0
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�Qj,,�REA EPLANNING REVIEWED BY DATE
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CHECKED 13Y ITYPE OFftfft C06E2 OCCUPAN,
GROUP
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SPECIAL INSPECTIO14 JAREA OCCUPANT 0 Fn
REQUIRED LOAD 0 r-
0 M
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REMARKS 90)
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE01D
Q 0
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VALUATION >
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Description FEE Description FEE
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Plan Check State Surcharge 0
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Suit �iermit city Surcharge M
IPLAI�YECK NO:
DATE
Plumbing
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Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
t:
Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
M. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
9 IN 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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
Landscapelnsp.
Total Amt. Due
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.-
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AP
LICATION 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; AN DON THE WORK AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED
D'N 0 11 RELATING TO
IN VIOLATION gFHE LABOR C-GQE OF THE STATE OF WASHINGTON
FOR IN SPECTION
building
k
Official or his/her Deputy: and Fees are paid, and
rt�.colpt is aknowlodged in space provided.
WORKMEN'S CO ENS UtCE AND RCW 18.27.
OFFI
SIGNATURE (PANER OQLENT)�
DATE SIGNED
(425)
Al
771-0220
DATE
-
_==j
RELEAT
AffPfTlOk
Off 1333
IT IS ALAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING