20050108.pdfDATE RECEIVED
y PERMIT EXPIRES
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CITY.OF EDMONDS ZONE I\`�- f Z NUMBER-1-��/`��-. Lee)�
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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NER NAME/NAME OF BUSINESS t/ .f `�— i i } �. l 1 'j1r L' �k '
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MAILING ADDRESS (,l `-� ��� /,�Z �' r}I / LID FEE $
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O ��� f-f!_� j 3)� 1+� 7 �•j ` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pormit Required (]
Street Use Parrett Req'd E3
CITYZlp TELEPHONE Z c' EXISTING PROPOSED Inspection Required 13
: Sidewalk Required
7 i y - REQUIRED DEDICATION Fr - Underground
i`f' %• 1 -.. .( �_ Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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C ADDRESS REMARKS i
_ _ OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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FIRE REVIEWED BY DATE W
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STATE LICENSE NUMBER EXPIRATION DATE C CKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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REO'D,• POSTED
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SEPA REVIEW SIGN AREA HEIGHT
a PROPERTY TAX ACCOUNT PARCEL NO, COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
❑ PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1:1 NEW RESIDENTIAL
ALLOWED PROPOSED FRONT SIDE RREARR FRONT UR SIDE REAR c7
1:1COMPLIANCE OR
ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE 1 0 f " f ` z
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D
PARKING PROVIDED AREA IP INNING REVIEWED BY DATE g
❑❑ GRADING ❑ FENCE X FT) REMARKS
REPAIR CYDS
❑ DEMOLISH ❑ TANK OTHe 07y _72
GARAGE IRE _ ❑ CARPORT ❑ R CKIERY WALL ❑ FIREALARMKLER
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(TYPE OF USE, BUSINESS ACTIVITY) EXPLAIN:
V .� CHECKED BY TYPE O VUCTION CO OCCUPANT��� oz.GROUP
nNUMBER NUMBER OF CRITICAL
OF DWELLING / AREAS SPECIAL. INSPECTION AREA OCCUPANT
O STORIES UNITS s" NUMBER REQUIRED YES LOAD
DESCRIBE WOAK TO BE DONE
REMARKS O
PROGRESS INSPECTIONS PER USC 108/IBC109/IRC109 FINAL INSPECTION REO'D 9
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK : w �,� VESTED DATE G+ Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT CO RS WORK TO
C BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
j DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr, Review
Lu PERMIT APPLICATION: 180 DAYS
d PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
y •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
3 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 OF THIS PERMIT SHALL NOT BE LandSCa a InS
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P p• Total Amt. Due 445
= 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 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 Official or his/her Deputy: arid Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
W RKMEN'S COMPENSATION INSURANCE AND RCW 18.27. ,
OFFICIA IGH E PATE
SI Tl) (O N OR AGENT) DATE SIGNED (425 �— - { !�
771=0220 RE AS BY D E
ATTENTIAN� EXT 1333 /D '
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL / j >/f �% lei
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL - FILE YELLOW - INS!"JECTO
PINK -OWNER GOLD-ASSESSOA
09/03 PRESS HARD =YOU ARE MAKING 4 COPIES
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