20050991.pdf1�"t%F—DXTE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
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CITY ZIP TELEPHONE
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[PERMIT EXPIRES
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PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑.
EXISTING PROPOSED Inspection Required ❑
Sidewalk Requited ❑
REQUIRED DEDICATIOrj�,,.F.T• erground
fling required 0
METER SIZELINE SIZE tJOor 'r. OF FIX B V REQUIRED
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REMARKS 11 !; ((ttt�i: ¢ �a 046 ij, " I i
OWNER/CONTRACT R ArSfF�I;1SIBL`E M9 �RU, ONTROL/DRAINAGE
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ACTION WATE9, HEATER ONLY INC (�
.TOTEMCOMMERCIAL CENTER1 �"� ENGINEERING REVIEWED/DATE
0 ADDRESS 1271)4 NE 124th ST 9 43
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AND � FIRE REVIEWED BY DATE w
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STATE LICENSE NUMBER EXPIR ION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBq INSPECTION BOND
'•� REQ'D POSTED.
crio�d'5:5'1 l f7%7 ❑YES ❑IG
SEPA REVIEW SIGN AREA HEIGHT
a PROOPEERRTTYJ_AAXX[AQC+OUNT PA CEL NO. COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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e / 3 .+ o C �OC J EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR O
❑ ADDITION ❑ COMMERCIAL ���❑'''COMPLIANCE OR
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CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE a
REMODEL ❑ APARTMENT ❑ SIGN REO'D I PROVIDED
GRADING FENCE
❑ REPAIR' ❑ CYDS ❑ ( X FT',
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE
z ❑ CARPORT ❑ RETAINICXERNG WALL ❑
RENEWAL
P: (TYPE OF USE, BUSINESS O ARTI ITY) EXP •AIN:
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. NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
oSTORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
edAS -01 011(16- 7`V 3S',ti<b `Ci�fS'
CHECKED BY. T F ONST N CODEOCCUPANT
GROUP
SPECIAL INSPECTOR A OCCUPANT
REQUIRED ❑ YES LOAD
REMARKS O
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
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VALUATION FEE
PLAN CHECK FEE 04f
HEAT SOURCE. GLAZING % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
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 GRADINGlFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
M SEPARATE PERMISSION, I j Q
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PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT: 1 YEAR • PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
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w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEIPT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
iNOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.` REC 00TOTAL AMOUNT OUE p � S
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 011icial 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 COMPENSAT10SURANCE AND RCW 10.27.
O ALS IG RE DATE
SIGNATU E (OWNER 01�� ENT) D7,,/rGNED/
(425)
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,l- 771-0220l
RELEA D Y ATE
A NTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
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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