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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAMEOF BUSINESS I
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21-6-6
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PERMIT EXPIRES -
USE
ZONE
PERMIT
A66806
JOB
-NUMBER
SLIM
ADDRESS
L
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Oro �2
PLAT NAME/SUBDIVISION NO.
IOTNO
LID NO�
LK) FEE B
PUBLIC RIGHT .1 -A' PER OFFICIAL STREET MAP
11
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EXISTING —
PROPOSEO�
X Rl
FEOUlR5D DEDICATION—
FT —
V . .....
METER SIZE
LINE 511E NO, OF FIXTURES
PRV REQUIRED
I
I
yes 0 No
REMARKS
ADDRESS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
ZIP TEL PHONE
NAME
ENG114EERING REVIEWEDIDATE
ADDRESS
Fil E REVIEWEDBY DATE
!2 CITY
VARIANCE OR CU SHORELINE OR ADB9 MSRPEEO�ION IPBOND
STATE LICENSE NUM ER
EXPIRATION
I
DATE CHECKED By
C STEG
OYES ONO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
,
Xp
LOT COVERAGE REQUIRED SETBACKS FT1 PROPOSED SETBACKS (FT)
NEW
RESIDENTIAL PLUMBING I MECH
ALLOWED PROPOSED FRONT SIDE REAR FRO I NIT. � URSIDE REAR
C3 ADDITION
cl C
C] COMMERCIAL CO PLIANCE OR
HANGE OF USE
PARKING LOT AREA EVI DATE
Ew P;,?,,
C3 REMODEL
APARTMENT SIGN
REO'D I PROVIDED
W
0 REPAIR
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AD0 2-000
A GE
Cl GARPORT
C
RETAININYG WALL
B CX.E
0 RENEWAL
Fp--m IT 0 LF-,
(TYPEOF BE. BUSTS
OR ACTIVITY) EXPLAIN:
CHECKEDBY
JT���
ROU
luccupAW�
NUMBER
N MBER OF
CRITICAL
Al SAS
SPEC NSPECTOR OCCUPANT
OF 7
STORIESEW.P,40:SMOUNITS
DWELLING
NUMBER
LOAD
UJA YES IMEA
RED RED
DESCRIB NE 7 Ab dtl
REMARKS
PlAnGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'
C' FEE
PLAN CHECK FEE
P L A C H E
HEAT SOURCE GLAZING %
I 11VESTE1
LOT SLOPE %
L 0 T S LOPE
I L I.
BUILDING
B U
E C K N 0
PLAN CHECK NO:
A N C H
PL
A T E
-TE. DATE
IN G
PLUMBING
P L U
_4 9-9,
—
MECHANICAL
MECHANICAL
P. OR
E M C VE W K
IT -
THIS PERMIT AUTHO MIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T I SIR M I A
I`ZBE
.
T IN ON HE P BL`C
T
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DONE' N "'ATE p
U
-FA O'N.'T'LL
GRAOINGIFILL
-
ETC I WILL P EQUIP E
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS' MARQUEES. ETC.) WILL REQUIRE
DID
TTE
SEPARATE PERMISSION.
fAF
SURCHARGE
a SURCHARGE
PERMIT APPLICATION: 180-AYS
PEI
0 WITHIN 1" DA'S
PERMIT LIMIT. 1 YEAR ' PROVIDED W RK 15 STARTED WITHIN 180 DAYS
IT IN T 1 YEAR
E F L
REVIEW FEES
ENG. REVIEW FEES
END
AT'ON
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SEE BACK '
AND E.CDEE-AS
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
P C SS'. NS
-A P I ANT ON BEHALF I
D INSPECTION FEE
END, INSPECTION FEE
EN
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I HARMLESS THE CITY ,
EST. A. EES TO NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
T EREST A.F EE S TO
IN IN T
1'." ER
ANDSCAPING
L SCAP7N
LAN.
. AGENTS FROM ANY AN.
2 NDI. WAH=TON. :TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ED. NCS WASHI NGTON
. NCREDT��
CTION FEE
INSPECTION FEE
INS,
DIRECTLY OR
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
UL C MS OR DA A
SHALL NOT BE
4 '
FROM THE ISSUANCE OF THIS P I PUI�l T SSUANCE OF THIS PERMIT
PRO THE ISSUANCE OF
OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
M . CIFY WAV. OF RED E AINY REQUIREMENT
DEEMED To MODIFY. WAIVE
DEE E . To . ORDINANCE PIROVISION.
NOR LIMIT IN ANY WAY THE C ITY'S ABILITY TO ENFORCE ANY
NO L ,.,T,N ANY WAY T. E
TOTAL AMOUNT DUE
I HERE ACKNOWLEDGE THAT I HAVE READ THEIRS ApRpTLIHCATIONY THAT THEZINFORMATIO,,
THE DULY AUTHORZ ED AGENT OF
DU AUTH E
,E WE 0
GIVENUY CORRECT, AND THAT I AM TH 0 OR
�i N T
TATE A - REGULATING CONsT�,uc�
'S ST L W E , DO S RUE
WITH CITY N 6 L WS C.
CALL
THE OW ER, AGREE To COMPLY
I 0. WILL - E PLO
p S L E. .
0 THE EBY 0 R WIL
WORK AUTHORTZED F,.Y No 'EFS N BE m
TION: AND IN DING TH E R
To
E L " G To
A N
FOR INSPECTII
W S NGTON RELATING
TE 0 W S I T
, E 0
IN VIOLATION OF THE LABOR CODE OF TH TAT F A HIN ON R
E S
WORKMEN'S COMPENSATION INSURANC AND RCW 18.27.
SIGNATURE AGENT/
C� TE SIGNED
(425)
771-0220
EXTJ333
ATTEOON
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-
CATE OF OCCUPANCY HAS BEEN GRANTEO. UBC SECTION 109
FAX
VALUATION I FEE
0001
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ORIGINAL FILE - YELI.W-INBIECT.H
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing..................
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wait .....................
Pier/Porch .................
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Retaining Wall ...........
Stab Insulation ..........
0 M
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PLUMBING:
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Underground .............
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Rough -in ...................
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Commercial Final
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Equipment ............ .
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Floor Insulation
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IT!
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SPECIAL INSPECTION
MISCELLANEOUS ..........
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ID
DA-FE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB S"'TEIAIT"
CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME)NAMEOF BUSMESS�..,' PLAT NAMEISUBDIVISION NO. ro. LID NO,
tA" \ , , e—, e_ LID FEE S
MAILING ADDRESS I .. P _�. 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP R'W F',,U.I, Rl E]
LAD I.— F d C3
EXISTING — PROPOSED— R 0
CITY ZIP TELEPHONE 1110 0
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5'.
METER SIZE LINE SIZE NO, 01 111TURES PRV REQUIRED
NAME
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REMARKS
OWNERICqNTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
N ME
ADDRESS
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CITY
ZIP TELEPHONE
DATE
SHORELINE OR ADERI INSPECTION BOND
NUMBER
POSTED
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STATE LICENSE
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TAX ACCOUNT
PARCEL NO.
EA HEfIGHT
C SERA REVIEW SIGN AR PROPOSED
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE W61K NOTED. THIS PERMIT COVERS WORK TO
NEON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
I
MAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
DED
:J SEPARATE PERMISSION.
SURCHARGE
PERMIT APPLICATIO N: III
KI
PERMIT LIMIT. I YEAR - PROVIDED WOR S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEEBACK OF PINK PERMIT FOR MORE INFORMATION
in F
ON BERAL OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
in ;APPLICANT.
�j N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLES.S THE CITY OF
LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS ROM ANY AND
ALL LAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
OF THIS PERMIT SHALL NOT BE
INSPECTION FEE
DEPOSIT
---
THE ISSUA CE OF THIS PER.IT. ISSUANCE
F 0 Cl E
EE EDTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY TYORDINANC
PLAN CHECK
OR LIMIT IN ANYWAYTHE CITY'S ABIUTY TO ENFORCE ANY ORDINAN
TOTAL AMOUNT DUE
RECEIPT
Ij
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORM�IION
APPLICATION
APPROVAL
GIVEN IS CORRECT� AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Th,, pPt, n.1 . p11 bnlil 11pld by Inn,
T EOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGVATILN.G.C�ONP TRUC
H 'L.YED
CALL
5,,Id,,g OII'c al 0, n,i IF— — ind.
IN
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSO, WIL
TO
FOR INSPECTION
I.—pt i� Ilk..Wlodgod in p... pnov,dod.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHIN TON RELATING
WORKMEN'SCOMPENS ION INSURAN2'ANDRCW 18.27.
CE I ALS SIGNATURE DATE
SIGNATURE
ATE SIGNED
(425)
n —
/4
771-0220
.&E
EXT 33
ATTENTION
10/5-4)
ITIS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
771%21
A FINAL N PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
S
YELLOW - INSPECT R
OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
GOLD ASSESSOR
I