20000446.pdf"A"
[PERMIT EXPIRES JL—L—�—,D
us[
P E..T
CITY OF EDMONDS
ZONE Z;�2_
NUMBER
CONSTRUCTION PERMIT APPLICATION
ADDRESS
JOB ()?,Z
TEII�j
E�p NAMENAME OF BUSINESS
NO
PI -AT NAMEISUBDIVISION NO.
LOT NO.
C
LID N Q
LID FEE $
ING ADDRESS
F . STREET MAP
PUBLIC RIGHT OF WAY PER OFPtCIAL
E PIM-4
T T_
IR q
p R-11 ED
p R.q A E
V�
ZIP ELIPHO E
EXISTING PROPOSED
t::rRV
=oq
p P.-(31
k .q 13
um
UM",
A�.
IT
REQUIRED DEDICATION
FT
W ,
w %g� �q
PRV REQUIRED
FE.0 'RED
AITE. S— LINE SIZE
NO OF FIXTURES
E
I
YES 0 NO 0
REES
REZATIS-1-1— .11
. P.NSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
JTEIEI"111
NAIZ
C--
REVIE;�EDIDATF
EHGINEERN
/vo IZ�ocr
BY
FIRE REVIEWED D BY
DATE
CITY ZIP ELEPHON.
0
HECKED By
STAk;�
VARIA.CE OR U
TI.N PS.
SHORELINE OR ADEN INSPEC '-
RE OSTED
0 Y.,, NO
oil ],qE.1IHAHONUAI1
A
SERA REVIEW
SIGN AREA IGHT
COMPLETE EXEMPT
ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO
EX, I
I I
—PROPOSED
NEW RESIDENTIAL PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT SETBACKS (FT.)
FRONT SIDE FEAR FRONT URSIDE FEAR
0 ADDITION COMMERCIAL COMPLIANCEOR
Cl CHANGE OF USE
PARKING
LOT REA
REMODEL APARTMENT SIGN
C]
REDO I PROVIDED
GRADING FENCE
0 REPAIR CYDs , — X IT)
EMARKS
0 DEMOLISH TANK OTHER
GARAGE RETAXIENRINYG WALL C] RENEWAL
CARPORT FOC
(TYPE OF USE. BUSINESS 0
;,pC
ONSTRUCTION 0
GROUP
NUMBER
N
CR TICAL
AREAS
IAL INSPECTOR
AREA OCCUPANT
LOAD
OF
'o STORIES
0 .,ELL
NUMBER
ED
RED R ..
DESCRIBE WORK TO BE DONE
EMARKS
PROGRESS INSPECTIONS PER UBC 11USIFINAL INSPECTION REQ
Se,
I --I A
z
m
c m
0
80
m m
m z
z
>
0
M M
0
0
0 m
c CA
m [j)
M 0
z
z
W
z
PLAN CHECK FEE
HEAT SOuHcE .1LAZING
LOT SLOPE %
BUILDING
m
PLAN CHECK N&__
rEST11 DATE
11UmB1 G
ECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERM IT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING"ILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEIS, ETC.1 WILL REQUIRE
SEPARATE PERMISSION.
SU CHARGE
PERMIT APPLICATION: I.. DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
,App,CAN,�O%BEHAL, OF HI�S OR HER SPOUSE HIIRS. ASSIGNS AND sUcCESORs
M NIFY, DEFEND AND HOLD HARML EBB THE CITY OF
ENG INSPECTION FEE
LANDSCAPING
N'NTEFEE R ST.,..
ITS ENTS FROM ANY AND
INSPECTION FEE
ECTLY OR INDIRECTLY
REC IPT
ERMI T SHALL NOT BE
PLAN CHECK DEPOSIT
ANYC ITY ORDINANCE
CHANCE PROVISION.'
REGE`7
TOTAL AMOUNT DUE
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AIPLICATULN� THAT HE IEN�FoRVATION
' R IIAE . ALT..RI, AGENTOF
-APPLICATION APPROVAL
w
IS CoFFEC
GIVEN T. AND THAT' A" THE '*"ND
TO ..FLY .1H cI1YA STATE LAWS REGULATING CONSTRUC
CALL
' 'P' '"d —K .1.111�11121.
D 'y
THEOWNER. I AGREE
TION AND IN Dol NO THE WORK AUTHORIZED THEREBY. NOPERSON—LRE EMPLOYED
RILITIN. TO
FOR INSPECTION _--d pd -� �1— 11--d
IN - E LABOR CODE 01 THE STATE OF WASHINGTON
WORK "�jo.)T�H
HSATION INSURANCE AND RCW 18.21,
0 FICIALSSI ATURE
1A I
IIATILINL
(425)
771-0220
LEAS D By AT
EXT 333
ATTEhTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL N PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
I S
ORIGINAL FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSE55OR
5-
*LAW%"
LOT i oor S.P. * Cm 41 S. " t
ILIT"i air womagAM J)z
f4e&%k
A ~ux
VOL
r (4,20 -53
w
-e-
0,
APPROVED 81 PLANNING
IKI
0
a Lai
w
> =3
0
U
w