20000183.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
tO� M
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
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ADDRESS
x
CITY ZIP TELEPHONE
NAME
p ADDRESS
ZIP TELEPHO
STATE LICI'NSE NUMBER EXPIRATION DATE I ;TIED BYNN
17 eo1
2,3 5�49A WIzeAW
PROPERTY TAXACCOUNT PARCEL NO.
4q1 ._ vv - d 1 v -- 40
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH
❑ AUDITION �j COMMERCIAL ❑ COMPLIANCE OR
CHANGE OF USE
❑ REMODEL C] APARTMENT SIGN
REPAIRGRADING, 3 FENCE
❑ ❑ CYDS ❑ ( X FT).
❑ DEMOLISH ❑ TANK ❑ OTHER
❑ CARPORT ❑ RETAINING WALL ❑ RENEWAL
ROCKERY
(TYPE OFGA!
, BUSINESS OR ACTIVITY) EXPLAIN:
7 g!
NUMBER NUMBER OF CRITICAL r�
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE '
0 Q PERMIT EXPIRES I C w
CT
USE PERMIT 200.11,'13
ZONE - NUMBER ,1..7
JOB SUITE/APT#
ADDRESS ►7&01 Lemke. &J k 4o
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TESCP Approved ❑
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required ❑
Street Use Permit Req'd ❑
EXISTING PROPOSED Inspection Required ❑
Sidewalk Required ❑
FT
REQUIRED DEDI Underground
r. Wiring required.
METER SIZE E' I C . NO.Of FI PRV REQUIRED
NO ❑ z
ES ❑
o[
W
REMARKS r'"'" ' =�` G S,� i
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION Ci]N f DRAINAGE a
REVIEWED/DATE
FIRE REVIEWED BY DATE w
LL
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
wm�REO'D POSTED
RM' � ❑ YES UO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT 4LOWED PROPOSED I ALLOWED PROPOSED
EXP I N vVi
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
Z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
REO'D PROVIDED
CyaAt�Fln e✓ o ISA'. R�EI-rr�N r
CHECKED BY TYPE OF CONSTRUCTION ICQOE OCCUP N
GROU (
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SPECIAL INSPECTOR ARE OCCUPA T if
REQUIRED ❑ YES LOAD
REMARKS O
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 6
VALUATION FEE
PLAN CHECK FEE w'
HEAT SOURCE GLAZING 0/6 LOT SLOP BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
H BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
F SEPARATE PERMISSION, (
URCHARGE
tx PERMIT APPLICATION: 180 DAYS
ul
n PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY RECEIPT , Q�\
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT `, 7 �C l uV
of DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
= NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." RECEIPT /� r
TOTAL AMOUNT DUE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICA ION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. 1 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: and 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.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICIA NAT DA E
SIGN TURE (OWNER O GENT) DATE IGNED (425)
RELEASED DATE
ATTENTION EXT 3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771'0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI GINAL. FILE Y LLOW •1 SPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION
s�/1019 FAX PINK -OWNER GOLD -ASSESSOR
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