20000775.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHO E
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NAME
-F 00 1 PERMIT EXPIRES
USE PERMIT
ZONE C�_ NUMBER a.0 077-S
JOB ED T91APTI
ADD85SS
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PLAT NAMEISUSDIVISION ��LO UO NO, u
Lt. FEE I
PUBLIC RIGHT 01 WAY PER OFPICIAL STREET MAP 11
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EXISTING - PROPOSED - 'Z' = � " 12
PEOUIREDDEDICATI.- FT - ,d
.ETEF SIZE LINE SIZE .0, .1 FIXTURES PRV REQUIRED
YES 0 NO 0
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAEIt
CITY ZIP
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ONE
NAME
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ENGINEERING REVIEWEDIDATE
c ADDRESS
1HIF FIEVIEWED.1 DATE
CITY ZIP
I TELEPHONE
VARIANCE OR CU
SHORELINE OF AG.It
INSPECTION
0 YRE 1&0
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION E CHECKED BY
Rllhl-Tt;�IXO PA j?1-,XlD
SEPA REVIEW
COMPW, EXEMPT
EXF
------;IGN AREA
OSEO
HEIGHT
A PROPOSED
PROPER' TAX ACCOUNT PARCEL NO.
ma-7-00D-014- 0-7
'�NEW 0 RESIDENTIAL 0 LUMBING I MECH
C3 ADDITION COMMERCIAL 0 COMPLIA CE R
CHANGE OF USE
0 REMODEL 0 APARTMENT 0 SIGN
0 GRADING FENCE
0 REPAIR CYDS 0 1 X _ FT)
0 DEMOLISH 0 TANK
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A
0 GAP 0
R GE RETAINING WALL 0 RENEWAL
CA FORT
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS(".)
FRONT SIDE REAR
o 00
PROPOSED SETBACKS N`T�)
FRONT UPSIDE REAR
MINE REVIEV
REMARKS
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
F_
CHECKEDBY ITrICAONIIRUCIONe
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PA
COU 'T
n ROD A
NUMBER
IN OF
STO IES
NUMBIll F CRITICAL
DWELL N AREAS
UNITS NUMBER
SPECIAL INSPECTOR JAREA ANT::
REQUIRE Fl.A7.
DD�YES
DESCRIBE WORK TO BE DONE
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REMARKS
-GRESS INSPECTIONS PER UBC 1108IFINAL INSPECTION REDID
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unl?l TZ
VALUATION
FEE
PLAN CHECK FEE
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NEAT SOURCE GLAZING %
LOT SLOPE %
BUILDING
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PLUMBING
PLAN CHECK NO: (Ir _7
3_V ____
VESTED DATE
MECHANICAL
THIS PERMIT AUlRi.lSR.AlTll 'L' THE "'I ll'Tll,.NTPUl PERMIT COVERS WORK I
V I ' E V N .A. C. STRUCTiON ON THE PUSUC
BEGONE ON PR, E PF"" -T - L
DOMAIN ITS SI .. ALKS R"B_A,., A..UEES, ETC,) WILL REQUIRE
SE�ARID`E
GRADINGIFILL
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEE
4 -A PLICANT, ON BEHALF 0 SIGNS AND SUCCESORS
P F HIS OR HER SPOUSE, HEIRS, AS
DEFEND AND HOLD HARMLESS THE CITY OF
IN INTEREST. AGREES TO INDEMNIFY,
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AMC)
LY OR INDIRECTLY
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECT ALL NOT BE
OF THIS PERMIT, ISSUANCE OF THIS PERMIT,SH
PLAN CHECK DEPOSIT
RECEIP
2-?3
-T
7,2�
FROM THE ISSUANCE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF AMY C Ty ORDINANCE
To VO
_-�4
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY I ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
REDD T -
If V,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
APPLICATION A PROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
TNI IPP-110I 11 'It 11 11
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Build,, Offi-I �l hIt'l.,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
.,, NP... vovw-I
IN VIOLATION OF THE LABOR CODE OF
WORKMENS COMPENSATION INSURANCE AND RCW 18,21.
FFI ON E OPT
-SIGMA
DATE SIGNED
(425)
12�
ol I'D LOO
771-0220
DATE
—
EL AS�D I
7TTENTION
EXT1333
UNLAWFUL TO USE OR OCCUPY ASUILDING OR STRUCTURE UNTIL
771-0221
IT IS
INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
ORIGINAL FILE - YELLOW, INSPECTOR
A FINAL
BEEN GRANTED. UBC SECTION 109
FAX
I`INK - OWNER - GOLD - ASSESSOR
CATE OF OCCUPANCY HAS
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SETBACKS ............
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PLUM13ING:
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FIRST FLOOR FRAMING
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INSULATION ................
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Wall Insulation ............
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS
FINAL APPROVAL FOR V'S
OCCUPANCY ..................
77
PERMIT EXPIRES
USE PERMIT
0 (i�l -NUMBER, ajD.07
CITY P'EIDMONDS' ZO I NE 7S.
'E OONDS
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JOB SUITVAPT#
ERMIT APPLCATIO
CONSTRUCTION PERMIT APPLI.CATION ADDRESS
PLAT NATYISUBDIVISiON NQ' j—"NO-
OWNER NIAMEINAME ��E�INES��,
LID FEE $
MAKINGADDRIESS PUBLIC RIGHT OFWAY PER OFFICIAL STREET MAP �'T-I,App—
EXISTING
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;D
'CITY
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NAME METER SIZE Ll,.ESIZ No. O� �!XTyRES I FRV REQUIRE?
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" MARKS '�J
51
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CITY z IF TELEPHONE
0
NAME
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ENGINEERING
ADDRESS
FIRE REVIEWED By,
DATE
CITY zip TELEPHONE
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INSPE D
RANGE OR CU
SHORELINE OR ADSI
BE ED
STATE LICENSE NUMBER 1 I DATE CHECKED By
I 0�
0 YES 0
—,G.AREA
2-Lb
BE REVEEWMPT
EIGHT
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ETE
ALLOWE 3 PROPOSED ALLOWED PROPOSED
TAX ACCOUNT PARC L
IT N'4
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-LL4=
-D, OT
EXP
LOT COVERAGE
REQUIRED SETBACKS: (FT.) PROPOSED SETBACK$ (FT)
FRONT URSIDE REAR
MENTIAL.
RES 0 PLU..INGIMECH
ALLOWED PROPOSED
�RONT� SIDE REAR
F
C PLIANCEOR
CIA
0 ADDITION COMMERCIAL o CHANGE OF USE
F&VIEWEDBY OAT
PARKING
q
AREA 17
0 REMODEL 0 PARTMENT C] SIGN
J.OT
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DING FENCE
0 REPAJA� GRADING DS IT)
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0 DEMOLISH 0 TANK
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0 (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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CHECKED
OCCU
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NUMBER
NUM51R OF CRITICAL
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DWELLING AREAS
;�Mr
OCCUPANT
LOAD
OF
STORIES
UNITS NUMBER
REQUI.EOAYE,
DESCRIBE WORK TO BE DONE
REMARKS
P OGRESS INSPECTIONS
R
PER USC 108/FINAL INSPECTION REO'D
5
621,421 ZI
�VALIJAOON
FEE
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HEAT SOURCE
SUIL
Lo
PLAN CHECK NO: b FED DATE
PLUMBING
7
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
IS PERMIT AUTHO RZES'
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
I AT'
N ON PA V
BE Do E
GRADINGtFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
DOMA 'C R DS p
' S'
'I
SEPARATE PERMISSION.
L
D
STATE SURCHARGE
IF PE MIT APPLICATION: 160 DAYS
R L ARSPROVIDEOW FIX IS STARTED WITHIN 180DAYS
-A.
A. PERMIT LIMIT. I YE 0
IT. I
END. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
y
S -A 'K OF
;A"ILI.IA.IT - jDA1.1ERALF IF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
11 N BEHALF I
MNIF�, DEFE AND HOLD HARMLESS THE CITY OF
NT FEET A.F B TON"B NO
FEES To
L"'
ENG. INSPECTION FEE
`AM=7MM
NINT.
I EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
'N.T-N
'EE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
R DAMAGE
THIS PER. HOT BE
P OST
RECEi
FROM THE ISSUANCE OF THI S PERMIT. ISSUANCE OF "SHALL
NCE
DEOMED TO MODIFY , W 'VE REDUCEANY REOUIREMENTOF ANYO TY ORDINANCE
'Y'WAIVEOR
A
PROVISION.
PLAN CHECK
RECE IPT
0 NOFL'M'T IN ANY WAYTHE CITY-SABLITY TO ENFORCE ANY ORDINANCE
MIT
NORLI TINANY
TOTAL AMOUNT DUE
I EF�.Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICAII.N; THAT THE INFORMATION
APPI ICATION AP AL
ULY
DIV. IS CORRECT. AND THAT I AM THE: OWNER OF THE D AUTHORIZED AGENT OF
'!RO
CITY AND STATE
T EOW LAWS REGULATING CONSTRUC-
N." 'A..E'T.,;..PLYWT.
CALL
I'll. I, 11.
B.: T
TION; ANO,tN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
, .... pt —k—f.dg.d m —F- p—d,d.
FOR INSPECTION
IN VIOLAT ON OF THE LABOR CODE 0 THE STATE OF
WORKMEN'S COMPENSATION INSURANCE AND DOW 18.27.
—
OFFI ION RE OAT
12—�
GIAT T DATE St NED
0
(425)
L
771-0220 REL ASE By DATE
EXII 333
uf&�'
ArMONTION
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-
ORIGINA L,lILl YELLOW � INSPECTOR
ASSESSO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD -
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