20050997.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMVE/IME OF BUSINESS
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STATE LICINSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION
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MULTIFAMILY
REPAIR
GRADING . CYDS
DEMOLISH
TANK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY
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NUMBER
NUMBER OF
OF
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING %
PLAN CHECK NO:
XPIRES
Usk PERMIT
ZONE NUMBER
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PLAT NAME/SU B DIVISION NO. LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHTOF WAY PER OFFICIAL STREET MAP RW Permit Raq I od
FPERMIT E
Street Use Permit Roq d
EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT Underground
-1 NO. OF FIXTUR Wiring required
METER SIZE LINE SIZE ES PRV REQUIRED
YES C3 NO E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE ORADB# I INSPECTION BOND
BY REO'D POSTED
13Y
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
EXP I I
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PLUMBING/MECH
LOT COVERAGE
REQUIRED SETBACKS ( )
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
COMPLIANCE OR
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CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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( X FT) REMARKS
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FIRE SPRINKLER
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CRITICAL I
AREAS
NUMBER
SPECIAL INSPECTION
REQUIRED I [] YES
JAREA_'
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
$ /40/ 96�*
Description
FEE
Description
FEE
Plan Check
State Surcharge
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LOT SLOPE %
Building Permit
City Surcharge
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VESTED DATE
Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT ILIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
1
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Receipt #
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Total Amt. Due
0
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
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Receipt N
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
WP'PLICATION APPROVAL
T14E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAI36*,Q0DE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTION
This application Is not a permit Until signed by the
Building Official or his/her Deputy; and Foes are paid, and
receipt Is acknowledged in space provided,
WORKMEN'S COMPENSAT
,X3t4\1NSLM6NCE AND RCW 18.27.
(425)
I 771-0220
EXT 1333
OF)`tjCIfLA SIGNATURK DATE
SIGNATURE (OWNER OR I GEN-Q
DATE SIGNED
109 ;4K 4�s
FIE A B
DAT
AlrT- E hT 10 N
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL () _<�-6
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 0)#IN- FILE YE LOW - SPE TOR
K .
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 K - WNER OLD - SESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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