20050996.pdfDATE RECEIVED PERMIT EXPIRES
SPIN
USE PERMIT
CITY OF EDMONDS ZONE NUMBER u y 7
JOB SUITE/AVq
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS
A— � PLAT NAM EIS UBDIVI SION NO. LOT NO. LID NO.
&I L (2 /-4- LID FEE $
a: MAILING ADDRESS
TESCP Approved [3
7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
0 Street Use Permit R&q 'd
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CITY EXISTING — PROPOSED Inspection Required E3
ZIP ITELDNE Sidewalk Required 13
011`7� — (�� REQUIRED DEDICATION Fr underground
,FIN fn 1,,L! — Witing required 13
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NAME METER SIZE LINE SIZ E NO. OF FIXTURES PRV REQUIRED
YES 0 NO 13
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ADDRESS REMARKS 2
X OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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NAME
ENGINEERI G REVIEWED BY
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PROPERiY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT I 91p; illpi At D PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
El NEW RESIDENTIAL P(!9 96M ALLOWED PROPOSED FRONT SIDE . REAR FRONT UR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYDS 1:1 ( — X FT) REMARKS In addition to We required
El DEMOLISH El TANK 0 OTHER pressur valve� in
GARAGE E:i RETAINING WALL [3 FIRE SPRINKLER
z El CARPORT ROCKERY FIRE ALARM listed expanslull t1ink shall be
[TYPE OF USE, BUSINESS OR ACT ITY) EXPUYN:
CHECKED B CODE OCCUPANT
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2 NUMBER NUMBER OF CRITICAL
a OF DWELLING AREAS SPECIAL INSPECTION- AREK --- — -------- OCCUPANT
M UNITS NUMBER REQUIRED [:] LOAD
0 STORIES YES
DESCRI13E WORK TO. BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC I 08/FlNAL INSPECTION REG 0
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I W A I FEE Description FEE
chu dw /_1' Vigo I?fh Description
Plan Check State Surcharge
HEAT �OUDCE If GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO.: VESTED DATE Plumbing ow) Paw
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN jCURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
tz Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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
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
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OFTHIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PR . OV SION. Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
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 Olticial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE-bM�Qa CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rccelpj�s acknow.lodged in space provided.
WORKMEN'S COMPEN�ATK)N,,"ANCIE AND RCW 113.27.
RE (OWN A N DATE SIGNED IG A�,UnRE DUAT E
(425)
�AkAl' 0,27- 0. 771-0220 RELEASED Y �:DATEJ
A17ENTION Off 1333
IT IS UNLAWFUL 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
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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