20000619.pdfDATE�jlru
I
Z�w 0
PERMIT EXPIRES
USE
PERMIT
20C
CITY OF EDMONDS
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
A, SOAITI
h
OV�TE07;ESS
P�,71RJSUBOIVISION NO.
LOT NO.
N
L 0
cx- c_Snr,)
11 FE
L�D S 74,
I MAILING ADDRESS I
PUBLIC RIGHT OF WAY PER
OFFICIAL
STREET MAP
C,
(01—
n.p-1
E03
CITY ZIP TELEPHONE
EXISTING — PROPOSEO�
I-'.lU-Aj,.d
1 II.10.d 0
REQUIRED DEDICATION
FT
2
METER SIZE
1INESIll
O,OFFIXTLRES
PRV REQUIRED
NAME
I
I
yes [3 No
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
ADDRESS
CITY ZIP TELEPHONE
NAME
ENGINEERING
REVIEWEDIDATS
C ADDRESS
FIRE REVIEWED By
DATE
CITY ZIP
TELEPHONE
z
VARIANCE OR CU
SHORELINE OR ADEN
17PECTION
BOND
STATE LICENSE NUM ."Y' WjRATIqNGATE.
CHECKEOSY�
OYREO'D
ES 0 NO
I POSTED
SERA REVIEW
13MPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
EL
PROPERTY TAX �;OU!,�� c
I Y_
<;
EX'
-TC."' A E
REQUIRE SET CKS JFT.)
PROPOSED SESTIBOACKS (FTI I
*NSVV
�6 RESIDENTIAL
PLUMIINGIMEOH
ALLOWED IRCIPOSE.
FR ONTO SIDBA REAR
FRO] N UR REA
COMPL ANCE OR
5
33.
ADDITION
C] COMMERCIAL
cl HANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED
By DATE
REMODEL
C) APARTMENT
C) SIGN
REDID
I PROVIDED
FENCE
-A2& YD. x FT)
REPAIR OR I X
19 — —
REMAHK5
— 0
DEMOLISH TANK cl THER
IGARAGE 0 BET INYGWALL 0 RENEWAL
Z CARPORT 0�11N
(TYPE OF USE. BUSINES V EXPLAIN:
CHECKEDBY
ITYPE=CTION
"E
ffDE
NUMBER
UM UUN
W E
CRITICAL
AREAS
SPEIIALIKEPECTOR
OCCURA T
LOAD
OF
STORIES
NITS
N MBER
U
JAIII
REQUI ED
E] YES
4:,
+
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REWD
3
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING I
LOT SLOPE %
BUILDING
pLAN CHECK NO:
�VFSTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURDS, SIDEWALKS. DRIVEWAY S, MARQUEES. ETC.) WILL REQUIRE
r
SEPARATE PERMISSION,
afi�/Qj CHARGE
PERMIT APPLICATIO N : 180 DAYS
PERMIT LIMIT.- I AR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
YE
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. A SSIGNS AND SUCCESORS
ENO INSPECTION FEE
;APPLICANT. TY OF
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. WASHINGTON ITS OFFICIALS. EMPLOYEES. AND AGENTS FRO. ANY AND
INSPECTION FEE
M G WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
ALLCLAIMSFORDA A EiOF
SHALL NOT BE
RECEIPT
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
C
5 E OR REDUCE ANY REQUIREMENT OF ANY ITYOHDINANC
DEEMED OMODIFY.WAIV
PLAN CHECK DEPOSIT
0
I NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ROMANCE PROVISION.'
TOTAL AMOUNT DUE
RECE P
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORM TION
)N APPROVAL
GIVEN I CORRECT. A D THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
S 7TO
. 1 0 �, b, -
COMPLY WIT" CITY AND STATE LAW
THE OWNER. I AGREE S REGULATING CONSTRUC-
CALL
0 F d
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKVEN S COMPENS INSURANCE AND RCW 18.27,
FICIALS SIGNAI I, DATE
AGENT)
DATE SIGNED
(425)
2z v
S 1)9
-7
1
c
11 1 #�!!�
771 -0220
R EASEDBY DATE
,VUREOWNER
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 CERT4FI-
ORIGINAL FILE YELLOW INSPECTOR
HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK-OWNVR GOLD -ASSESSOR
CATE OF OCCUPANCY
5,98
z
�n
c a m
M
0
80
c
M
M z
jO
0 -n
.n
m m
a
0
0
C ca
M C-)
Z
X
z
cn
z
0
0
m