20000473.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMMAME OF BUSINESS
MAILING ADDRESS
.7 :z gev
CITY ZIP ITIL11HON1
vzo 57 9,?e a 6
us'
PERMIT
ZONE
NUMBER
JOB
SUITEIAPT.
ADDRESS s
PLAT NAMEISUBDIVISION NO,
LOT No*
LI NO,
LID FEE S
1ES11AN,1-11 0
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
P., A.
EXISTING — PROPOSED-
c
REOUIRED DEDICATION—
FT
==d
.ETER SIZE
LINE SIZE
MO,OFFINTUN�l
PRV REOWRED
I
I
Yll� Cl NO
RE ARKS
ADDRESS
NERICONTRACTOR RESPONSIStS FOR _EROSIONCONTAOUDRAI-GS I
CITY =ONE
NAME
;5�e,v �l
&--
ENGINEERING REVIEWEDIDATE
/--� A —
"ADDRESS
a ee.-
FI
3
'CITY ZIP
T�e
PF/y I/
- fl� a
I
fARlAI,J.E [.0
SHORELINE OR A.BI
IN-P—ON
REO'D
IPBO
OSTED
STATE LICENSE —NUMBER EXPIRATION D rE
CHECKEDBY,��:
SiWREV?fiw
-.1-1. EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWE PROPOSED
D
I
vlo A:20
--,:R�op��ERT�YTAX-;�CCO5�
PARCEL NO.
EXP 1
__ I -
— --
LOT COVERAGE
REQUIRED SETBACKS IFT."
PROPOSED SETBACKS (PTI
NEW 0 RESIDENTIAL PLUMBING/MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UPSIDE REAR
COMMERCIAL ri COMPLIA CE OR
I
C] ADDITION - CHANGE OF USE
PARKING
LOT
NNING REVIEWED BY DATE
0 REMODEL cl APARTMENT 0 SIGN
PEGG
I PROVIDED
0 GRADING CYOS 0 F NCE
[3 REPAIR I —X—FT)
E
L!
0 DEMOLISH 0 TANK o OTHER
o GARAGE 0 lllTAlNllly6 WALL 0 RENEWAL
R ORT , F,
CA GO
_._
(TYPE OF USE� BUSINESS OR ACTIVITY) EXPLAIN:
CHICKEDGY
— -JCODE
I OCCJPAN;q
JTYIEOFCONSTFU��TJON
NUMBER
U
NO 0
SlIECIALINSPECTOR
OF
Ries
ow L ING
UN T
AREAS
NUMBER KJP�
JAH-
REIOU'G�o YES
L.A.
PLAN CHECK FEE
HEAT SOURCE GLAZING
J
LOT SLOPE I
BUILDING
PLUM51NG
p - -
-
PLAN CHECK NO:
- E
OAT'
,
100 `� -2—
:
jVE5TlD
W ORK
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Y'
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON,THE PUBLIC
DONE ON PRIVATE PROPERTY ONLY
LL REOUIR
ILL. DU
S, MAROUEES, ETC.) W E IRS
GRADINGIFILL
WAY
2 DOMAIN (CURBS. SIDEWALKS DRIVEW,
S,
:1 SEPARATE PERMISSION.
t
STATE �YRCHARGE
2 PERMIT APPLICATION: ISODAYS
L10
PSAMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
p I NT. B ALF F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN I TE EST, A EES T :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
FROM MY AND
2 E N S. ASHIN T N. r 5FICIALS, EMPLOYEES. AND AGENTS
INDIRECTLY
INSPECTION FEE
ALL I S A ES F HATEVER NATURE, ARISING DIRECTLYOR
Fp E I S NOE F THIS PERMIt ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
F
0 DIE E T IFY� AIVE R REDUCE ANY REOUIREMENTO ANYCITY ORDINANCE
N RLI IT N N AYTHE ITY'S ABILITY TO ENFORCE ANY OR li DINANCE PROVISION,
TOTAL AMOUNT DUE
I "EREBY LEDGE THAT � HAVf READ THIS APPLICATION; THAT THE INFORM ION
AUTHORIZED AGENT OF
GIVE "=T . AND THAT A. HE OWNER, OR THE DULY
WITH CITY AND SET" T' LAWS REGULATING CONSTRUC
CALL
THEOWNER I AGREE TO C044PLY
W ED
AUTHORIZED THER Y.No P- -N ILL - E.PL-YT.
DOING THE WORK
TIC E. A.HIN. N FE A IN.
N AND IN , W SL T
IN VIOLATION OF THE LABOR CODE OF THE STAT
FOR INSPECTII
WORKMEN S COMPENSATION INSURANCE AN. RCW 18.27.
1IGNATUA (OWNEROR Nfl
(425)
771-0220
EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING 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
FAX
VALUATION FEE
aim-, "o
" \LAct GQ ta
PT
APPLICATION APPROVAL
Thl. .1pl-11- - P-It -Mll �191-1 by
80d,,g Offidw- Doputy� a,d F- - PlId.
.... pj-lk-Wd90d-0lwPl-d.d.
IALS IIGNAT�URI DATE
D
E#L DAT
ORIGINAL - FILE - YELLOW - INSPECT%,
PINK � OWNER . GOLD - ASSESSOR
z
a m
c
M
0
3:
0 -n
m m
055 : !
0
0 Fn
c
m
z 0
z
0
m
FINAL, PROJECT APPROVALEAM
TO-
-DATE:
MEMO TO: P7E7n J..PIA OR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE 4�
G E G DIVISION DATE -
PLANNING DIVISION DATE
PROJECT L1)6516'0�- C4461-
SITE ADDRESS ZZ20/ t�':0`02r
C:
01
I p,;,
5--ADB#—DATE INSPECTED— —7 9� /aO
i
PERTflT
MM:
DESCRIPTION OF WORK TO BE INSPECT
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
n
Final approval of the described work
MM
0
Bonds associated with the project may be released
erformance
:J�GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
01
AILED FINAL INSPECTION - OUTSTANDING ISSUES
0
M
2.
3.
_RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp:bldg:forms6/98