24017 101ST AVE W.PDF11111 1 11111
24017 101 ST AVE W
DATE RECEIVED
PERMIT EXPIRES
CITY OFEDIVIONDS
USE PERMIT
ZONE
NUMBER,2W2 0�6
CONSTRUCTION PERMIT APPLICATION
JOB PuqFJAPT#
ADDRESS )01,;4� �0�
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OWNER NAMEMME OF BUSINESS
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PLAT NAME/SUBDIV[SION NO.
LOT NO.,.
LID NO.
LIO FEE $
M
MAILING ADDRESS
(4 o lot
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
TES Approved
RW candt Required
permit Raced
inspection Required 13
Sidewalk Required 13
Underground
Wiring required 0
CITY ZIP
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TELEPHONE
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NAME
METER SIZE
W4E SIZE
NO. OF FIXTURES
PRV REQUIRE
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
CITY ZIP
TELEPHONE
NAME
6 1113,
ENGINEERING REVIEWED/DATE
ADDRESS
A
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FIRE REVIEWED BY DATE
IE
CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
13YES [3NO
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
,
0 i PO
EXP I
,
I
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NEW WAESIDENTIAL de?)MECH
ADDITION COMMERCIAL' COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REOUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
PARKING
REO'D PROVIDED
LOT AREA
PLANNING REVIEWED BY -DATE
REMODEL 0 APARTMENT [j SIGN
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9
-
REPAIR GRADING FENCE
CYOS X Fn
REMARKS
DEMOLISH 1:3 TANK o OTHER
RE
..PARAGE I RETAINING WALL
CARPORY 13 ROCKERY RENEWAL
(ME OF USE. BUSINESS OR A3W
CHECKED BY
TYPE OF CONSTRUCTION
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60�E
OCCUPANT
GROUP e!)
N UMBER
OF
STORIES 17
NUM BER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTOR
REQUIRED
[3 YES
AREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC JOB/FINAL INSPECTION REO'D
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VALLIATION $
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Description
FEE
Description
FEE
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Plan Check
HKSOURCE GLAZ[NG % L Building
PLAN C14ECK NO'. VESTED DATE Plumbing
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(./C;p 17% T
. 1 Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PFRMIT COVERS WORK TO
BE DOME ON PRIVATE PROPEMY ONLY. ANY CONSTRIJUTIO" ON THE PUBLIC
DOMMN (CURBS, SIDEWAr Vq Grading Recording Fee
TE EFI:,=Ukf
.&TVEPWA W. EM.) LIL REQUIRE
t: S TE PE S819
Engr. Review City Surcharge
PERMIT-APPLICATIOW.. 180 DAYS
AL PERMIT LiMn! 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr.inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION State Surcharge
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Tratfic Mitigation Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS. I HE C1 I V OF
NY AN D
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS MOM ANY AND Fire Review Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
'REC T L y
FROM THE ISSUANCE. OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
L NOT BE
!3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Inspection Total Amount -Due F�
"IMNANCE
10VISION . -
0 NOR umrr IN ANY WAY THE CrryS ABILITY To ENFORCE ANY ORDINANCE P ISION.'
�ROV
Landscapainsp. Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
ORMA . noN
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- gTh =oaflon not a permit until signed by the
' MPLOY CALL I.r 'a"
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED SUR Mather Deputy: and Fees are paid, and
IN VIOLATION 05,� LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ecelpt Is acknoy4edged In space provided.
WORKMEWS,"WENSiXTION INSURANCE AND RCYY 18.27.
F SIGNATURE DATE
AGEFM
PNA DXT.E�PIGNED (425)
ZRS
171-0220 E 0 .1 Y
04A E 4,
ATTENTION Off 1333
IT 16 UNLAWFUL TO USE OR OCCUPY A BUILDING Q_8,STRUCTURE UNTIL 7-6 1916)2-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 ORIGINAL - FILE - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
10/01 FM PINK -OWNER - GOLD -ASSESSOR