20000330.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNS MANE/ ME OF BUSINESS
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REQUIRED SETBACKS (FT.)
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PROPOSED SETBACKS(FT.)
FRONT VRSIDE FEAR
❑ COMPUANCE OR
ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE
PARKING I
LOT AREA
PLANNING REVIEWED BY DATE
REMODEL ❑ APARTMENT ❑ SIGN
REO'0 I PROVIDED
❑ REPAIR ❑ GRADING CYDS FENCE ❑ ( �_ X FT)EMARKS
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F (TYPE USE.B INESS ACTIVI,YI EXPLA
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CTE OCCUP T
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w NUMBER
o OF
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NUMBER OF
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UNITS YYY
CRITICAL
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NUMBER
SPECIAL INSPECTOR
REQUIRED ❑YES
AREA OCCUPANT
- LOAD
DESCRIBE WORK TO BE DONE
REMARKS
oonr_oeee iNSOFr.TInNS PER DEC 1981FINAL INSPECTION REG'
PLAN CHECK FEE
HEAT SOURCE GLAZING Y LOT SLOPE %
BUILDING
PLAN CHECK NO: VESTED DATE
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PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
ETC.) WILL REQUIRE
GRADINGIFILL
DOMAIN (CURBS, SIDE WALKS, DRIVEWAYS, MARQUEES,
7
t SEPARATE PERMISSION.
STATE SURCHARGE
PER APPLICATION: 180 GAYS
PERMIT LIMIT: i YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OR SI
CITYES
'^ 'APPLICANT ON BEHALF OF OUSE,END
ENO. INSPECTION FEE
A D HOLD 14AR LESS TH F
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
O MN"HERDE
INT'MMON.E.WASHINGTON, ITSOFFICIALS,EMPLOVEES, AND AGENTS FROM ANYAND
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ALLCLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLYORINOIRECTLY
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BE
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SMALL NOT
ORDINANCE
PLAN CHECK DEPOSIT'
OEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANYCITY
THE CITY'S ABIUTYTO E NFORCE ANY ORDINANCE PROVISION,'
iNOR LIMIT IN ANY WAY
TOTAL AMOUNT DUE
MATION
I HERE DY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT T.THE INFORENT OF
THAT; AM ECITYANDSTATELAWSREGULAINGCONSTRUC,
THE GIVEN ISOWNER.RPECIAGREETOCOMPLYWTHAND
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTU
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION MN RANCE AND RCW 18.27_
SI6 TUBE (OWNER OR ENT) AESIGN
(425)
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771-0220
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EXT 333
ATTENTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5118
VALUATION I FEE
a permit unlit siOPad by
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Gas Piping
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Ceiling Insulation
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
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OCCUPANCY
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A ATE RECEIVED 2. 1
PERMITEXPIRES
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j CITY OF EDMONDS �'NE NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNE NAMEINAME°F BUSINESS /NO
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PLAT NAME/SUBDIVISION NO, LOT NO,
LID FE
LID FEE $
MAILING ADDRESS }
7,41 nbA 0.L6',I vA ,wV1
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PUBLIC RIGHT OF WAY PER OFFICIAL MAP
EXISTING PROPOSED -
REQUIRED DEDICATION FT
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CITY ZIP
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NAME
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METER SIZE
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NO.OF FIXTURES
PRV REQUIRED
YES O NO
ADDRESS ! \(\�`(
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION GONTROVDRAINAGE
CITY ZIP
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P ONE
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NAME / '
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ADDRESS
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FIRE REVIEWED eY DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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of
❑ NEW
RESIDENTIAL ❑ PLUMBING I MECH
❑ AUDITION
COMPLIANCE OR
❑ COMMERCIAL ❑ CHANGE FUSE
REMODEL
❑ APARTMENT ❑ SIGN
❑REPAIR-
FENCE
❑ GRADING CYDS ❑ ( X _ FT)
❑ DEMOLISH
❑ TANK ❑ OTHER
GARAGE CARPORT
In
❑ RETAINING WALL ❑ RENEWAL
(TYPE USE, S INESS
EXPIAI a'
rACTIVITY``)
NUMBER
1
NUMBEROF�
DWELLING
CRITICAL
AREAS
OF
STORIES OC
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
REO'D POSTED
AYES ❑NO
SERA REVIEW SIGN AREA HEIGHT
COMPLETE ( EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
AIJLOWED
P
LOT COVERAGE REQUIRED SETBACKS(FT.) PROPOSED SETBACKS(FT.)
'PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED
CHECKED BY TYPE OFC TION 'yT+�y't�.r GROUFL% 2
5PECIALINSPECTOR AREA !!!d OCCUPANT
REQUIRED REQUIRED ❑ YES LOAD
REMARKS
PROGRESS INSPECTION$:PER UBC 108/FINAL INSPECTION
VALUATION FEE
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PLAN CHECK FEE
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HEAT SOURCE GLAZING %
LOT SLOPE
BUILDING
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PLAN CHECK NO: j
VESTED DATE
PLUMBING
M
MECHANICAL
-
THIBPERMITAUTHORIZES ONLY THE WORKNOTSM TNIS PEflMIT COVER.......
CONSTRUCTION --THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY.ANY
DOMAIN (CURBS.SIDEWALKS,DRIVEWAYS, MARGUEES; ETF)W.CREQUIRE
GIT ING/FKL
SEPARATEQERMISSION.
STATE SURCHARGE41
wPERMIT APPLICATION: 180 DAYS
o. LIMIT. YEAR PROVIDED WORK IS STARTED WITHIN 180DAYS
END, REVIEW FEES
PERMIT
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
L
m 'APPLICANT. ON BEHALF OF HIS HER SPOUSE. HEIRS, D HARMS ANDLESS HE CITY OF
HOLD HARMLESS THE CITY °F
ENG, INSPECTION FEE
_
NI
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND
ANDAGENTSFROM ANY AND
f
yR Ct
YC�-# e
EOMONOS. WASHINGTON, ITS OfFIC1ALS.EMPLOYEES,
1. ALL CLAIMS FORDAMA GES OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
I
RECEIPT
h
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT
DEEMEDTO MODIFY, WAIVEOR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE .
ENFORCE ANY ORDINANCE PROVISION.'
PLAN CHECK DEPOSIT
gECEIPT Cam`
i NORLIMI TIN ANY WAYTHE CITY'S ABILITY TO
TOTAL AMOUNT DUE
C�1
l✓L("J (,/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, ORTHE °LILY AUTHORIZED AGENT OF
STATE LAWS REGULATING CONSTRUG
-CALL
This application is not a pprmlt until signetl by the
Deputy: end Fees arp paitl. and
THE OWNER. (AGREE TO COMPLY WITN CITY AND
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BEEMPLOVED
TO
INSPECTION
BuiltlinO OJI6c for hislher
rncaipl is ecknowled0ptl in space provitletl.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASH(NOTCH RELATING
FOR
- ATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.21.
OFFICIAL SIGN TURE
A)3EnnSIGN(JED
(425)
cp
SIG TURE (OWNER OR GENT), `
/�
U Sneer i hJ'N (#�/
K °�" ^ L/
771 ^U220
RELEASED Y DATE
EXT 333
Z ,
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
77.� ^022i
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI•
°RPGNK LowNER • GOLD ASSESSOROR\'1\
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX