20000430.pdf'I DATE RECEI
__L—I� . ?. .0
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
CITY ZIP TELEPHONE
NAME
) G
PERMIT EXPIRES 1
USE
ZONE 'S _ i -2_
PERMIT
NUMBER
4X:43r)
.7-7
TEIAPTO
ADDR,S":5—qr) 12--+,\
Il==.-
PILAT NAMEISUBDIVISION NO.
LOT NO..
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAI
TES—pp-0
RW
P—h R.q d
EXISTING PROPOSED
d
AT,O
REQUIRED DEDICATION
FT
U,
VI,
NIETERIIZE
LINE IIIE
NO, OF FIXTURES
P RV REQUIRED
I
YES 13 No 0
R MARKS
OWNERICONTRACTOF, RESPONSIBLE
FOR EROSION CONTROUDRAINAGE_
� � I) le- \� 1 1.1
(A
ENGINEERING
REVIEWED-5
ADDRESS
"(3I,9,1� 41/-�
:�__Sz2c
FIRE REVIEWED BY
DATE
�ELEPHONE
C)-
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
I BOND
STATE LICENSE NUMBER
EXPIRATION
1 ED BY
REO'D
E3Y�S ONO
I POSTED
SIGN AREA
HEIGHT
W
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT
PARCEL NO,
I
,
EXP I
. —
—
LOT COVERAG
REQUIRED SETBACKS (PT-)
PROPOSED SETBACKS (FT)
0 NEW
RESIDENTIAL
PLUMBING I MECH
PFOPES�U
ALLOWED 0
FRONT SIDE REAR
FRONT R SIDE REAR
u
cl ADDITION
ro
COMMERCIAL
0
COMPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA PLANNING REVIEWED
BY DATE
C] REMODEL
0 APARTMENT
[3
SIGN
REGO I PROVIDED
REPAIR
C3 GRADING CYOS
'ENCE
( _ X _ FT)
DEMOLISH
TANK
ci
OTHER
GARAGE
C ARPORT
RETAINING WALL
_.FFY
al;iNEWAL
CHECKEDBY JTY�
C .....
ER .1 AL SPE IAL I NS� -T�F
GUR
: ED
LIN E ': PECIALINSPECTOF
NUMBER LWEL 0 AUCA S
OF NI N MBER REQUIRED 0 YES
$TO IES TS_
DESCRIBE WORK TO BE DONE
PLAN CHECK FEE
HEAT SOURCE GI-AZING %
LOT SLOPE %
BUILDING
-PLAN CHECK NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ONITHE PUULIC
GRADINGIFiLL
E '.E
W . W , U
DOMAIN (CURBS. SIDEWALKS, DRIVEWAY . MARQUEES. ETC I WILL REG IFE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 1110 DAY.
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
S S El.RS
'APPLICANT. ON BEHALF OF HI ORHER pEO�UEE I CITY F
P TION FEE
G I N'PEC"ON FEE
EN S EC
G. IN
Ng,�,.,LGSHIAIISA�I�ITS.IC
� AGREES TO N NIFY. DE, RMLE
ININTERESWT :TDOFF$CIALS' FROM ANY AND
D A ING
LANDSCAPING
L SC P
FE
FEE
E
EMPLOYEES. ANDA
EDMONDS NGTON SEM DENTS
. ASHI OR INDIRECTLY
INSPECTION
I ECTON
NE
ALUCLAIMEFOR GAMAGE� OF WHATEVER NATURE, ARISING DIRECTLY
PERMIT .15 PERMIT SMALL NOT BE
ISSUANCE OFT
]MEN;
C Epo SIT
PLAN CHECK DEPOSIT
.
;;
FROM THE ISSUANCE OF THIS
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REGUIRENIENTO F ANY CITY ORDNANCE
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINA-1 I --
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONY. THAT THE INFORMATION
By ACK.N.0 A HORIZED AGENT OF
F ULY UTH
OTRATTEF DUS AUT
GIVEN IS CORRECT, AND THAT I AM THECGWNENA
H TYA 6S LA , U T, C C. BTFUC
W G
THEOWNER I AGREETO COMPLY Wil RE LATING CONSTRUC
CALL
7 ION AND IN DOING THE WORK AUTHORIZ THEREBY, No PERSON WILL BE EMPLOYED
TO
FO R INSPECT11
T'D
1 N VIOLATION OF THE LABOR CODE OF HE STATE OF WASHINGTON RELATING
WoRKMENSCOMPE=ION INSURANCE AND RC,718.27
(425)
sIG7
,�/E(DWNE OR GENT
71
7 -0220
A17ENTION
EXT 333
IT IS UNLAWFULTO 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. USC SECTION 109
FAX
I
�c) IN I LOAD
PER UBC I 081FINAL INSPECTION
VALUATION I FEE
� l 1.1 �1, b,
11 ,Vho, Dop.ly — IW�-
.1klIld9ld � W." P-1dod
ORIGINAL -FILE - YELLOW INSIECTCR
PINK OWNER- GOLD ASSESSOR
z
0
Rl
'49
ra �
0 rn
c: a
m 0
80
c
m �
z
U)
io!
Dos
0
0
z
'9
0
m
. . . . . . .
. . . . . .
:,koTice7"IF
tHE'DbCIJMEkT IN THI, Ff��Mt 'S� LESS CLEAR tHANTHis NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
............
07 3: g
59
u
cm
at
Al
kw
MAILING
J
PERMITEXPIWES
USE
CITY OF EDMONDS ZONE
PERMIT
NUMBER
AlIr
S
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
ER NAMEJ��E OF
A
PILAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE
I=
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP R.
P 0
EXISTING � PROPOSED�
C
TELEPHON
0
REQUIRED DEDIOATION— IT — VIM, 111.d 0
TER SIZE
LINE SIZE
NO. OF FIXTURES PRV REQUIRED
NAME
YES E3 NO 0
ADDRESS
REMARKS
OWNERICONT-C— F F,R F.nPiGN CONTROU11111111
CITY ZIP
�REV'EWED'G�ATE
NAME
NGINEERING
ADDRESS
FIRE REVIEWED By DATE
z
J
ZIP TELEPHONE
VARIANCE OR CU
SHORELINE OR AD5N
INSPECTION
OYREG-D
ES E3NO
80 D
POSTED
STATE LICENSE NUMBER
INV-rT-:74
SEPA REVIEW
COMPLETE EXEMPT
AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED I PROPOSED
CEL NO.
EXP
I
LOT COVERAGE
HEOUIRED SETBACKS tFT.)
PROPOSED SETBACKS I"
PLUMBING I M
C] NEW CH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
0
o C MPUANCE F
ADDIT ON
I CHANGE OF USE
-40
C:
PEO"ARIKING
PROVIDE
AREA PILANNIIN GAT E
G REVIitO BY
REMODEL Cl SIGN
m
E] FENCE
REPAIR GRADING GYDS x
I
C
z
DEMOLISH TANK D
ARAG RETAKINIRNYG WALL QWN:E-WAL
GGAFPOET F.0 F
0 -n
-n
p EXPLAIN:
CHECKED
STIRUC ION
ON
occur
;R
P
ROU t
-4
3:
m m
NUMBER NUMBER OF
CRI.TICAL
AR S
SPECI IN 0 A�i�
OCCUPANT
OF DWELLING
STORIES UNITS
NUMBER
UALDSPE
REG IRE [] YE
LOAD
C��o -
0
0
C
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER LIBC 11081FINAL INSPECTION REO'D
C v)
M 0
z
z
--I
29
VALUATION
FEE
CID
z
PLAN CHECK FEE
0
�EAT SOURCE GLAZING
BUILDING 1,
0
m
PLAN CHECK NO:
PLUMBING
MECHANICAL
T.I.,PE..'T AUTHOFIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E DONE .. FVAT PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL RED IRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATIO ; ISO DAYS
PERMIT LIMIT. I YEAR -PROVIDED WORK 15 STARTED WITHIN ISODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEE S
F M OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ON BEHALF 0 S
END. INSPECTION FEE
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS ROM ANYAND
INSPECTION FEE
MAG OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
ALLCI-AIMS AC NOT Be
=AN
RECEIPT
F.. THE E CEST.IM PERMIT ISSUANCE .1 THIS PERMIT SHALL
DEEMED To MODIFY, WAIVE OR REDUCE ANY REOWREMENT OF ANY CITY CRDINAN E
PLAN CHECK EPOSIT
D
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINAN
m
RECEIPT
TOTAL AMOUNT DUE
I HER EBY ACKNOWLEDGE THAT t HAVE READ THI S APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN I CORRECT. AND THAT 1 AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
S
Thil ppl, t , po,mil u.jid 11,1d by -
THEOWNER. AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRU E C D
'ONG
CALL Bui,, 011i-I ., 1,m1h., D�pdI, -d F .1. p-,
TION; AND THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOY
'No I TO
OF WASHINGTON RELATING
I Jpld�d.
FOR INSPECTION ""'pi-, -we
IN VIOLATION OF THE,.LABOR CODE OF THE STATE
ATUR
WORKMEN$ COMPE=ION INSURANCE AND R41B.27.
FFICI LS 510
(425)
SIGN
/ /
=a2_
771-0220 le ASEDBY CATE
EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPE CTION HAS BEEN MADE AND APPROVAL OR,A CERTIFI-
ORIGINAL - FILE YELLOW INSPECTOR
BEEN GRANTED. UBC SECTION 09
FAX PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS
Sme