20000832.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
TELEPHONE
0/ INN-1 "N", A
IROPERTY TAX ACCOUNT PARC��
CO3 N E
RESIDENTIAL
LUMBINGIMECH
ADDITION
0 COMMERCIAL
o COMPLIANCEOA
CHANGE OF USE
C] REMODEL
APARTMENT
0 SIGN
REPAIR
__E7�z�
FENCE
El ( X FT)
0 DEMOLISH
TANK
OTHER
gGARAGE
CARPORT
RETAINING WALL
0 ROGKFHY
0 RENEWAL
(TYPE OF USE. BUSINESS
OR ACT[
NUMBER
NUMBER OF
CRI
OF
STORIES
DWELLING
UNITS
A
NU
DESCRIBE WORK TO BE DONE
.:f
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
HE BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
PERMIT AUTHORIZES '
[E DON' ON PRIVATE P
B
ICU
DOMAIN 'C RISS, SIDEWALKS, DRIVEWAYS, MARQUEES, eTC.j WILL REOUIRE
U G
3 SEPARATE PE MISSION.
f RMIT APPLICATION: 180DAYS
PE
P PER IT 't I I YEA. 0
ERMIT LIMIT, ' YEAR . PROVIDED W RK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUC ESORS
0
INDEMNIFY, DEFEND AND HOLD HARMLESS THE 1. 1 1
IN INTEREST AGREES TO
T
I EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
C D �,S.
LA M. FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
MAD
ALLCLAIMSFOR A IS
FROM THE ISSUANCE OF THIS PERMIT. U E OF THIS PERMIT SHALL NOT BE
0 S AND
To MOD, Y W IV, ANY REQUIREMENT OF ANY CITYOFIDINANCE
DEEMEDTO MODIFY, WAIVE 08 REDUCE
Y
C NORUMITIN4NY WAYTHECITY'SABIUTYTOE.FORCEA�Y09DINANCEPFtOVISION
PERMIT EXPIRES
PERMIT Z7
ZONE P-,)— NUMBER(�4i
OB
SUITLIAPTR
PLAT NAMEISUBDIVISION NO.
NO,
LED NO*
J.'LOT
LID FEE S
P SUC RIGHT OF WAY PER OFFICIAL STREET MAP
TE-Appl-d
RW P.-ft R1-
II.q,I
EXISTING — PROPOSED—
R90U]PEDDEDICATION— IT
m R SIZE
____T_
LIN. SIZE
N.- .1 EMTU�ES
V REGUIRED
YE:". No 0
111-NTRA-9 RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR AOBI
INSPI
RE
0 YEE
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
I
LOT COVERAGE
REQUIRED SET ACKS (FT1
PROPOSED SETBACKS (FTI
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT I UR SIDE REAR
I
L�T�.
REVIEWED BY DATE
P�.VK�.T
CHECKED 'Y JTYFIGFCONSTRUCTION 11COO5 I OmD
I
- st7EcIAI INSPECTOR lAFEA
PE
QUIP
REDU HE
YES
R�
PER UBC 108IR q
FEE
PLAN CHECK FEE
- - ___ I
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENG. REVIEW FEES
END. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUE
RE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
I�ATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CITY AND STATE LAWS REGU�TIN G CONSTRUC
CALL
-it
11
THE OWNER. I AGREE TO COMPLY WITH
IZEOfTHERESY, NO PERSON WILL 5 E EMP DYED
R7D
1plty� Ild Flll 110 plld�
TiON; AND IN 00 E %, aroF E STATE OF WAS HINGTON RE ATING TO
L
FOR INSPEC TION
'd
IN VIOLATION W=
KMEN 6 C N A N SU AN E RCW 18.27�
WOR RA C
7111CIALS SIGNATURE DATE
SIG UR
S��4
(425)
-02
771 l2v
RELEASEDBY DATE
W;D
EXT1333
AAAIIAwa , )
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGMAL-11LE - YELLOW. INSPECTO#
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLO-ASSESSOR
E198
z
0
m
M 0 , ,
0
0
c
M
M z
K) --I I :
O"n
.n
m rn
cl 16 , I
0 F
on
C 0)
9 co
M 0
z
71
z
z
0
m
1( DAT I HE PERMIT EXIPIRR-5
�GATE RECE.Vl�
'ONE
E
G
p DS USE PERMIT /7 9'saep"/
CITY OF EDMONDS ZONE N MBER I
CONSTRUCTION PERMIT tAPPLIC!ATION JOB SUITUAPTO
rADORESS
OWNER NAME.AME OF BUSINESS
D.IVIS'l LID NO.
PLAT NAME'SUDDIVIS"
g2&e,�j b L
to FEE $
MAILING ADDRESS
_�UBLIC RIGHT OF WAY PER .11IMAL STREIT MAP o"
P.- II.A. 0
E�ISTP,IG — PROPOSED —
CITY
W�IILEPIIONE R., 0
REQUIRED DEDICATION— IT —
I
NO, OF FIXTURES
PAV REQUIRED
NAME
YES 0 -NO 0
ADD SS
REMARKS
O�NI:RICONTRAOIOR�ESPONIIBIEFO�IIIOIIONCOIITROUI)RAI��GE
CITY ZIP TELEPHONE
io ;l-Thil, P'll,
N 'ME�
ENGINEERING REV EWEDMATE
DDRESS
FIRE REVIEWED By DATE
CITY Z
TELEPHONE
tc
z
INSPECTION
BOND
VARIANCE OR CU
SHORELINE OR ADS.
REaD
POSTED
d
STAT LICENS NUMBER
0 YES 0 NO
0
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PR?POSED
PROPERTY TAX. ACCOUNT PARCEL NO.
EXP
LOT COVERAGE
REQUI RED SETBACKS (FT.)
REAR
PROPOSED SETBACKS JFT.)
F UPSIDE PEAR
NEW
L
RESIPENTIA PLUMBING I MECH
OWED
ALL PROPOSED
FRONT SIDE ,
�,FIONT
rn
c
COMPLIANCE OR
rn 0
ADDITION
C] COMMERCIAL 0 CHANGE OF USE
—PARKING
0
LOT
AREA
PLANNING SEVII ED By DATE
0
8 c
0 REMODEL
C] APARTMENT SIGN
RE O-D I PROVIDED
I
I
-4 m
REPAIR
0 SPACING GYQS 0 IINIE
X IT)
I.A.KS
m mz
10
tD��OEMOLISH C] TANK o OTHER
c�
6ASAG
�kAS E 111TAIN1111 WALL 0 IIINEWML
C .. K"',
-4
cl)
(TYRE PROSE10USINES' 4
CHECKiDBY
0 'n
ITYPEOFOONST
n
NUMBER
----Tc,,,TA
NU .1
,cALd
ARE
-----
-----
OF
STORIES
DWELLING
UNIT.
NUMBER
MITI
o
DESCRIBE WORK TO BE 0 NE
REMARKS
0
-
PROGRESS INSPECTIO ER UBC 108/FINAL INSP
o
c: W
/7-
M C)
Z r
-4
VALUATION
X
PLAN CHECK FEE
z
S T SOURCE lAl NO % Lo SLOP
BUILDING
p
V"TED DATE
PLAN HECK NO:
P MINING
0
m
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLYAANY CONSTRUCTION ON THE PUBLIC
W MARQUEES! ETD
GRADINGIFILL
K,
2
D R.S
!�MAW (CU SIDEWALKS, DRIVE
SEPARATE PERMISSION.
.7
STATE SURCHARGE
PERMIT APPLICATION! TOO DAYS
PERMIT LIMIT. I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
L SEE BACK OF PINK PERMIT FOR MORE INFORMATION
INSPECTION FEE
-APPUCANT, ON BEHALF FN S OR HER SPOUSE Hlffll�.AISIGNS AND SUCCES.Ps
IN INTEREST. AGREES I "MN"y. OEF�.G X.. P. HARMLESS THE CITY OF
LANDSCAPIN
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
INSPECTION FEE
ALLCIJIlMS FOR DAMAGES OF WHATEVER NATURE, ARISING D RECTLY OR INDIRECTLY
NOT BE
T MIT. ISSUANCE OF THIS PERMIT $HALL
FROM THE ISSUANCE OF HIS PER
EMEOTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OFANYCITY ORDINANCE
PLAN CHECK DEPOSIT
55
DE
NOS LIMIT IN ANY WAYTHE CITY�S ABILITY TO ENFORCE ANY OHL-1.
TOTAL AMOUNT DUE
RECEI T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLI ATION AP
GIVEN IS CORRECT; AND CHATPLAIM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
' T'
III I
DIP W H CITY AND STATE LAWS REGULATING CONSTRUC-
T.0 . W,
WNE`�DRIPA. �ETO M LY I
T'I'V'lo OR
CALL
diPg 0 16 1 ' him/h. P. d.
LL BE LEMPLOY 0
TION'. AND IN 001 T E ORK U ORIZE THEREBY, NO PERSON Wi E
DIN R OE OF E STATE OF WASHINGTON RE ATIMG TO
S
FOR INSPECTION
Pd' n -i
1,,d P
ATI.N�g
IN VIOLA
I N ANCE D RCW 1827.
WORKME N JAT SUR
OFFICIALS SIGNATURE E
'�rSCO
,
SIG 4UR i&?&2�� NT)
DATESt ED,,
(425)
" //' __
a /
771-0220
RELEASED By
_WT-TENtIbN
EXT1333
IT IS UNLAWFULTO U�E OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION BEEN MADE AND APPROVAL OR A CERTIFI-
ORIG(NAL-RLE yEl,,W-INSPECT09
-HAS
HAS BEEN GRANTED� USC SECTION 109
FAX
PINK-OINNER GOLD -ASSESSOR
CATE OF OCCUPANCY
5198