20000305.pdfus
PERMIT
CITY OF EDMONDS
"N'
NUMBER
CONSTRUCTION PERMIT APPLICATION
jOB
ADDRESS
OWN E; ELI Sw
;Ar
LEGAL DESCRIPTION CHECK
SUBDIVISION NO, LID 10
.11ING ADDRESS
o
ME, A P--
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 0
0
0
CITY ZIP TELEPHONE
EXISTING — REQUIRED
DEDICATION
0
_20 1
PROPOSED
0
NAME
METEgsFZE LINE SIZE
NO, OF FIXTURES P V REQUIRED
'ES 0 NO 0
ADDRESS
REMARKS
CITY TELEPHONE
NINE
................
ENGINEERING MS.. BATED
IEWED By
ADDRESS
SlIva?'?
FIRE MEMO DATED
�EVIEWEDBY
z
1617X
0
CITY ZIP TELEPHONE
o
VARIANCE OR 75
ADSII SHORELINE
STATE LICENSE NUMBER EXPIRATION DATE HECKE
o? C4
SERA REVIEW
GO MPLETE EXEMPT
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED P"'OSIO
r, -4
LEGAL DESCRIPTION OF PIT PERTY INCLUDE ALL EASEMENTS
p I
I I
am
c:
a
LOT COVERAGE
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
rn
0
A LOWED PROPOSED
FRONT SIDE REAR FRONT URSIDE REAR
0
a
IN
L T AREA
LOT AREA
PLANNING REVIEW BY DATE
PLAI
rn
A L U M BN C 'S N
NEW ESIDENTIAL PLUMBING f MECH
REMARKS
R'PE AlKo
LANCM 0.
C PLIANCE OR
P
I�
COMMERCIAL C3 H A N OFUSE
E] ADDITION CHANGE OF USE
0
0 APARTMENT [3 SIGN
[3 REMODEL SIGN
]EC
F NOE
EN
X T)
REPAIR cl GRADING GYQS 0 X F T)
.NET
CHECKEDBY PF 0
Y
M
*TANK o OTHER
jlj��.NSTFIU)� pp� GCCUPA
ROUP
AM
rn
a 5;
C3 DEMOLISH
SPE AREA
SPECIAL IN CTO,
OCCUPANT
LOAD
0
0
RETAINING WALL RENEWAL
ROOKERY 0
JAREA
REQUIRED YES
c
c CA
REMARKS
mZ
.P
PROGRESS INSPECTIONS
R RES. IN
E C PER UBC 108
10
e
I
NUMBER
OF
NUMBER OF
DWELLING
C L
CRITICAL
nREAS
o
STORIES
N,
UMBER
OF CON
FINAL INSPECTION REQUIRED
co
d
VALUATION
FEE
z
PLAN CHECK FEE
!�REAT
LOT'�L
BUILDING
m
PLUMBING
PLAN CHECK NU:
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEQ THIS PERMIT COVERS WORK TO
BE DONE ON P81VATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIEC
GRADINGIFILL
DOMAIN (CURBS.SIDEWALKS. DRIVEWAYS . MAROUEES,ETC.) WILL III IIE
=r-RCHARGE
SEPARATE PERMISSIOM
P MIT APPLICATION: 180 DAYS
ER
F.
PERMIT LIMIT, I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
AINAGE FEES
STORM DRAINAGE FEEb
IPPLICANT. ON BEHAL F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN NTEREST. AGREES TO INDEMNIFY. DEFEND AND 140LO HARMLESS THE CITY OF
I
a EDMONDS, WASHINGTON, ITS OFFICIALS, E.PLOYEES, AND AGENTS FROM ANY AND
A LL CLAI FOR DAMAGES 01 WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
A M'
.UA CE 0, MIS P -RMIT SMALL NOT BE
F HE N I ERMIl ISSUANCE OF THIS PC
ED. T
PLAN CHECK DEPOSIT
o DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
X1 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
_
TOTAL AMOUNT Bul
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION, THAI illf INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTIVII1,1ED AGENT OF
Ly-
THEOWNER, IAGRE TOCOMPLY WITH CITY AND STATE LAWS REGULAIING CONSTRUC
E
CALL
1,
F111 - 11d, fl,Id
HON, AND IN DOING, THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TO
FOR INSPECTION
.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING
P--d-,I
I
WORKMEN'S COMPE NSATION INSURANC E AND RCW 18.27
URE IOWNER 0 1 DATErNED
(425
S IGN I D
SIG ',
771-02�20
IFLEA�EQ.y DATE
ATTENTION
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IT
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFk
ORIGINAL FILE YFLLOW'INSIEGION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK OWNER - GOLD ASSESSOR
z
0
4
0
m
m
m a
-4 0
0 0
C:
m
m z
0-1
c
0 -n
m m
055
o
0!;
C: (/)
9 C)
m 0
Z r- I
X
z
z
2
0
m
ocaprvl.doc.j:temp.bldg:fo-6/99
F _;�R:MlT:E'XPlRES
P L411&
I
FEDMONDS
CITY OF EDMONDS
USE PERMIT
L
ZON NUMBER
CONSTRUCTION PERMIT APPLICATION
6B SUIT /APT,
:5
�
ADDRESS
OWNER NAMEINAME OF BUSINESS
/j/ A
;r
LEGAL DESCRIPTION CHECK SVEICIPOISION NO, LID NO
I. MAJU;;�
I
0 sa 4
PUBLIC RIGHT OF WAY PER OF' iC AL STREET MAP TESCPAPPI-d
0
CIT ZIP TELEPHONE
EXISTING - RE RED DEDICATION SI-I P� A�qd 0
QUI
0
4;;>ej_ 46,7
PROPOSED 0
NAME
1. PEOWEE.
YES 0 NO E3
K
Is
I_ ADDRESS
REMARKS
IF
CITY I ZIP ITELEPHONS
NAME
ENGINEEM
ADDRESS
IF — a,.jq,-7X
�- CITY ZIP TELEPHONE
0
FIRE MEMO DATED REVIEWED BY
VARIANCE OR CU AGE. SHORELINE
T
IZ
z
0
A I ATE
STATE LICENSE NUMBER PIR ION
C-/z �/ 'z�o zighl
SERA REVIEW SIGNAREA HEIGHT
OMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
COMPLETE
Ee E
I, IN E E
"LEGAL DESCRIPTION OF PROPERTY, INCLUDE All
EXP
EXP I
-14
PROPERTY TAX ACCO T P CEL NO,
1.161LI f')C) _(l%r-i-2
a d
13 NEW IAL PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS IFT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
LOT AREA PLANNING REVIEW By 011
-RE-MARKS
I
US m
m 00
mz
ID -1
C3 ADDITION L Ei C MPLIANCE OR
CHANGE OF USE
c
>
REMODEL SIGN
,FENCE
C3 REPAIR GRADING CYDS 0 X PT)
C3 DEMOLISH -JATANK o OTHER
AGE - RETAINING WALL RENEWAL
o GAR F.CK.Y 0
CARPORT 0
GROUP
CHIECKEDBY I TYPE OF CONSTRUCIION OCCUPA:4
SPECIJALEtDNSFECTOR� 5A OCCUPANT
REDU R LOAD
YES
I
o n
m M
0
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
REMARKS
PROGRESS INSPECTIONS PER UBC 108
0 rr;
a ca
0
NUMB R
0
C ICAL
RIT
AREA S
NUMBER
DESCRIBE WORK TO BE DONE
;a
Iv./
e_l&,:�41 44CE 4-0;P4L 6IA4�1., Oww
A,,
FINAL INSPECTION REQUIRED
z
-4
--d CA4
VALUATION
FEE
ca
PLAN CHECK FEE
z
0
EATS URGE GLAZ G %
BUILDING
AO'
IT!
PLAN CHECK NO:
VEST
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E Ly. ANY .NST.UCTI
BEDONEON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
P
..B W YE,
DOMAIN (CURBS.SIDEWALKS. DRIVE A S, MARQUEES.ETC.) WILL REQUIRE
GRADINGIFILL
S�IWURCHARGE
SEPARAE PEF1.11S.I.N..
SE, E TBP R.
PERMIT APPLICATION: 180 DAYS ,.
- , I-�
-
PERMIT LIMIT. I YEAR, � PROVIDED WOAK IS STARTEDWITHIN 180 DAYS
sToF.bRAINAGEFE5S
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCEEDER
IN INTEREST, AGREES TO INDEMNIFY. DEPEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERM"' I SS ANCE OF THIS PERMIT SHALL NOT BEE
DEEMED To MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF ANYCITY OFOINANC
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
TOTALAMOUNTDUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTH RIZED AGENT OF
THEOWNER. JAGREETOC MPLY Wil H CITY AND STATE LAWS REGULATING CONSTRUC.
TION: AND IN DO NG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VI LAT,ON 05 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
ROVAL
APPLICATION APPROVAL
CALL 4
-I,: - F .10 p1d. IPId
FOR INSPECTION ,FAckt, g, -p-ap-Old
"k' 'gd
WORKMEN SCOMPENSATION INSURANCE AND RCW 18,27,
ENT1
E
02%0 FF LS lIGNAT E
7/&')
771-02 BE A-M.Y DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINA � FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK OWNER GOLD ASSESSOR