20051066.pdfa
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP
TELEPHONE
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW W90ESIDENTIAL MOO -PLUMBING / MECH
E ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
1:3 REPAIR 1:1 CYDS 11 1 X FT)
DEMOLISH 11 TANK 1:1 OTHER
GARAGE RETAINING WALL Ei FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE. BUSINESS ORjA'9TFVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
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STORIES UNITS NUMBER
DESCRIBE V16RI? ONE
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GLAZING %
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PLAN CHECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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 LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDOEMNIFN� DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
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DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HEREBY ACKNOWLEDGE THAT I H�VE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I P THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP/yt WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORYALITHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAB CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATW�9 INSURANCE AND RCW 18.27.
SIGNATURE (OWNER 0 N
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USE
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ADDRESS
I PERMIT EXPIRES
PERMIT
NUMBER 44K��T_
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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 Required
REOUIRED DEDICATION— FT
Underground
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 N 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
'NGINEERING REVIEWED BY DATE
BE ACCEPTED
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FIRE REVIEWED BY DATE w
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BO No A
REO'D POSTED 0
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10YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) M
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NILLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR M
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PARKING LOT AREA PLANNING REVIEWED BY DATE
OVIDED K
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REMARKS
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,HECKED BY TY OCCUPANT
GROUP —4
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SPECIAL INSPECT16N AhEA OCCUPANT M IT!
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3ROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
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VALUATION --I
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Description FEE Description FEE 3:
Plan Check State Surcharge z
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Building Permit City Surcharge 1
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171
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPEICATION APPROVAL
CALL This application is not a permit until signed by the
Build Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION—, ' /i?lrocelpt Is acknowledged in space provided.
FI A L SIPVNTU E
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(425)
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771-0220 RELEASED BY
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE.RTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING