20000301.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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FT TE LICENSE NUMBER
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pn�OPERTY AX ACCOUNT PARCEL NO.
7 6 7 - 0 2?
0 NEW C] RESIDENTIAL 0 LUMBINGIMECH
OMMERCIAL C MPLIANCEOR
0 ADDITION la`o COANGE OF USE
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FENCE
0 REPAIR X ITI
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NUMBER
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DESCRIBE WORK TO BE DONE
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FPERMIT EXPIRES
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PLAT NAMEJSUBOIVISION N& I LOT No LID NO.
U. FEE S
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REMARKS
OWNESICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
ENGINEERING ,10ATE
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FIRE REVIEWED By DATE
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ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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D I PROVIDED
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REMARKS
CHECKED By TYP F CON TRUCTION G OCCUPANT
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SPECIAL INSPECTOR AREA OCCUPANT
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REMARKS
PROGRESS INSPECTIONS PER U BC I 08/FINAL INSPECTION REQ
VALUATION I FEE
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_�Al CHIC' FEE
HEAT SOURCE LOT SLOPE I
BUILDING
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PLUMBING
ECHARICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIRLL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS � MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERM"TAPPL'CAT*N� "BBA'S
PERMIT LIMIT. I YEAR - P R.,,.E. .RK.. STARTED WITHIN 1131) PAYS
REVIEW FEES
ING REVIEW F
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
A CA HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
PPU NToN BEHALF OF I 01
ENG. INSPECTION FEE
No
I INTEREST. AGREES To ME HOLD 5 1 cT Y
, ?.lMN,lClY 'FIND AND HAIMUI S TI I
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EDNION ' .
INSPECTION FEE
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ALLCLA'.. FOR DAMAGE O�WHATEVER NATURE.ARISING DI ECTLYORINDIRECTLY
NOT U
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RECEIPT
E 'SSREGUIREMENTOFANY CIT'ALL
,no. TH ISSUANCE OF THIS PERMIT. UANCE OF THIS PERMIT
ORDINAN E
PLAN CHECK DEPOSIT
DEEMED To MODIFY. WAIVE OR REDUCE AN
WAYTHE CITY'S ABIUTY TO ENFORCE ANY QRDINANCE PROVISION.'
R,,Wct I tie
NOR LIMIT IN ANY
TOTAL AMOUNT DUE
—
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWN,%
DULY�AUTHQR�11E. AGEI,JT 01
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THE OWNER, I AGREE TYAN 'T ELA. �.U, No CONSTRUC
TO o PLYWITHCI
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W ON WILL BE EMPLOY E
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TION, AND IN DOING THE ORKAUTH ED THEREBY. NO PERSNrTON RE ATING To
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FOR INSPECTION
IN VI L 10 0 BE OF THE STATE op WAS"i
Go
DATE
WORKMEN'S CO.P ION HANC ew a 21
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OFFICIALS SIGNATURE
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DATE SK1101)
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771-0220
DATE
EL o B C
ATTENTION f- /
EXT 333
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OCCUPY A BUILDING OR STRUCTUREUNTIL
771-0221
ITIS UNLAWFULTOUSEOR
APPROVAL OR A CERTIFI,
ORIGINAL FILE - YELLOW. NSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD ASSESSOR
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CITY OF EDMONDS
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,,��ONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNA
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NAME
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FE E
PROPERTY TAX ACCOUNT -ARCEL NO,
57 0
0 NEW C] RESIDENTIAL 0 P UMBINGIMECH
0 ADDITION CHANGE OF USE
'E�"QO MM5RCJAL 0 C MPLIANCE OR
0 REMODE L rl APARTMENT
FENCE
[3 REPAIR,, ; f-I GFIA0111 CYDs FT)
E3 DEMOLISH 0 TANK 0 OTHER
oGARAGE o RITA.I.NiNrIVALL RENEWAL
CARPORT EGO , [3 -
0 WITY) ExP,ANa
rUMSER OF -.I.CAL
DWELLING ffj AREAS
UNITS NUMBER
bESCRIBEW RKTOBEDONE
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PERM[) EXPIRES
USE PERMIT
ZONE NUMBER
jos SUITEIAPT#
ADDRESS z -3 q�j o 0_>,
4
PLAT HAMUSUBDIVISION NO.
LOT NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
-0
EXISTING- PROPOSED-
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a.'anbe. 0
0
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO.OFFIXTURES
PRV REQUIRED
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YES0 NO 0
REMARKS
OWNEFUCONTSACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWEDIDATE
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FIRE REVIEWED BY DATE
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SHORELINE OR ADBN
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HEIGHT
ALLOWED PROPOSSO
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REQUIRED SETBACKS
PROPOSED SETBACKS (FT)
ALLOWED
FRONT SIDE SELZ
FRONT UPSIDE REAR
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PARKING LOTAREA
PLAN INGREVI BEY DATE
HE IDED
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REMARKS
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RED'
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VALUATION
FEE
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PLAN CHECK FEE =j
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HEAT SOURCE GLAZING %:::::Z LOT SLOPE I BUILDING
1111TED DATE PLUMBING
PLAN CHECK NO:
MECHANICAL
THIS TO
PEFIMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK
IS DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ONT Uo
USES , Em) WILILIE.P.N.'S GRADINGIFILL
DOMAIN (CURBS, 11DEWALKS* DRIVEWAYS, MARO
SEPARATE PERMISSION. STATE SURCHARGE
ERMIT APPLICATION: 100 DAYS
.. rp..MIT M..11 1 YJEApR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
N.8EPALFOFHI ORHE SPOUSE, "IIRS. ASSIGN ANDILICCE1011
ENO. INSPECTION FEE
;,APPLI.C'A
NT �JDA P EST. INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
INSPECTION FEE
- F TS FROM ANY AND
EDMOND WASHINCITONL,16TFS 0 FtCIALS, EMPLOYEES. AND AGEN
ALL CLAIMS FOR DAMAGES ?WHATEVER NATURE.ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0, DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOUISEMENTOF ANY CITYORDINANCS
TOTAL AMOUNT DUE
0. NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATI N APPROVAL
GIVEN IS CORRECT. AND T I AM THE OWNER, OR T E DULY AUTHORIZED AGENT OF
"AT
The IPP111111- 11 all pomit until 11g,le by IP0
NE I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC -
THeOW R
CALL
Buildi.0 011alill 11 nutho, Deputy: ad Fees ano Paid. and
IN 00 E ON WILL BE EMPLOYED
TIONOAN IN = T..RIZE.T.E.E.1 NO I . I,GTON RELATING TO
THE STAT OF WASH
FOR INSPECTION
P,p.alu,Pw1.dg.d in sp� . �Pldd.
AD
IN ION 0 E OF
WOR P AN=CW 18.27,
OFFICIALS SIGNATURE DATE
Uj
771-0220 DATE
ATTENTION EXT 333 f
ITISUNLAWFULTO USEOR OCCUPYABUILDING 1111 STRUCTUREJUNTIL ci-)
CERTIFI- 771-0221 ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR