20001007.pdf/-4, DATE RECEIVED
t_ L .2- ;2
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IESMAMEINAME OF BUSINESS
� -+ 5, I-J
ZIP JTELEPHONE
�.ywf --) " -,
PERMIT EXPIRES
USE
PERMIT 20TC07
ZO"
UMBER
i
B
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT No
LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED-
..F
1110d 0
REQUIRED DEDICATION- PT -
�Ulll;__
CL
METER SIZE
LINE SIZE
NO, 01 INTURES
PRV REQUIRED
I
REMARKS
YES 0 NO
ADDRESS
OWNERICONT ....... RE EROSION CONTROUDRAINAGE
CITY ZIP
TELEPHONE
NAME
WENGINEERING
REVIEWEDIVATE
ADORE SS
5 01 dw fQ-Aho-
FIRE REVIEWED BY DATE
�.�Ty_ 4
I? /I
TELEPHONE
L/
VARIANCE OR CU
SHORELINE OR ADBI
INSPECTION
0 RE 'D
YES I -I NO
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION DATE
V 3
IJECKEU by
el
$EPA REVIEW
COMPLETE EXEMPT
SIGN REA
ALLOWED PROPOSED
HEIGHT
ALLOWED P90POSED
PROPERTY TAX ACCOUNT PARCEL NO,
_+=P
EXP I
,
C] NEW RESIDENTIAL PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (PT)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT UPSIDE HEAR
C3 ADDITION COMMERCIAL COMPL ANCE OR
CHANGE OF USE
PARKING
LOT A
PVREMODEL APARTMENT 0 SIGN
REO'D
I PROVIDED
-;T
C] REPAIR A� El (FENCE X FT)
REMARKS
C] DEMOLISH TANK o OTHER
ci GARAGE RETAXININGWALL RENEWAL
z CARPORT ROD ER 0
(TYPE R ACTIVITY) EXPLAIN:
CHECK ED BY JTXP�PFCONSTRU
O.CUPAQ 1�>
GROUP
NUMBER
OF
o STORIES
NUM BE F
DW ��LING
U
CS IT A'
A, lA5
___, K)
-- L,
U OCCUPANT
P C 7A NSPECTOR REA
LOAD
E IRED 0 YES
DESCRIBE WORK TO BE DONE '�YD ,d,6
REMARKRS
PROG L INSPECTION REO'D
IP0931711ess OFWfiether the water system
V' 2 cl
------ —p—slon tanks are
ECDC 19.30.020(c) '..
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE
LOT SLOPE %
BUILDING
DATE
PLAN CHECK NO:
[VESTED
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE P80PERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
STATE SURCHARGE
ICATION: 1800AYS
I PPL 'CA
P RM T APPL
PE
PERMIT LIMIT. I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
R V' DED W
:
ENG. REVIEW FEES
MIT
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PER
PPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
I OF E R
A L L S
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E - Fy D
ANY AND
,ED
E
F IALS F
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS ROM
5
CLAI S OR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR I.DIR CTLY
I' G HATEVER
ALLCLAIMSFO E
JNW-G*WA�E
ECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
C S EFMT
PLAN CHECK DEPOSIT
. �M . T .0 1 Y W 1 0 Il
LICE
DEEMED TOMODIFY. WAIVEOR REDUCE AN' REQUIREMENT OF ANY CITY OROINANC
NORLIMITINA WAY THE CiTY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
D I NY W Y THE CTY S EI'LIT,
OR LIMIT NY
TOTAL AMOUNT DUE
RE EIPT
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN S CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Tho,,OpjbpIiF,bP po-ii unbl ,Qled by
GULATiNG
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS RE CONSTRUC.
CALL
S"I d1l .I ., Dpull: nd F- - P�',hT -
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
TO
INSPECTION -,,-p- --wl,dgld in space F,ov,dod.
IN VIOLATION OF THE LABOR CODE OF THE STATE Or WASHINGTON RELATING
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
FOR
5FICALS SIGNATURE DATE
SIGNATURE JOWNER AGE'
NED
(425)
-0
771-0220
e" , , _
LEASED BY
ii;i:� ka
AT7fNTION
EXT/333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFi-
ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
5/98
z
a m
m 0
80
c
m
m z
jo
c
0
m m
a
0
, R
C (n
c m
M C)
Z
z
p
co
z
9 ,
0
m