20001011.pdfVIED
A- DATE RECEI
CiTY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ME OF B SINESS
MAILINGADDITESS
7 Piv e- �J.
ZIP
1 TEL PHONE
NAME 73 D
CITY ZIP I TEL
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ROPERTY TAX ACCOUNT PARCEL NO.
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[3 RESIDENTIAL
er"PLU.-IN. I E.-
ADDITION
2- . ERCIAL
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CHANGE OF USE
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NUMBER
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OF
DWELL N.
AREAS. cp
STORIES
UNIT.
NUMBE
DESCRIBEWORKTO BE DONE
I PLAN CHECK NUn_ '" 1--
I THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE. DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE EPUBLE
LKS. DRIVEWAYS, MARQUEES, ETC.) WILL A CUME
DOMAIN (CURBS. SIDEWA
SEPARATE PERMISSION.
PERMIT APPLICATION: IBO DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-A' HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
I'LCA N T�%%E'IAL'
N,�TE.EE E TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDSSIAI"INIT" ITFSWOMFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
A.E�o AT EVER NATURE, ARISING DIRECTLY OR INDIHECTLY
ALLCLA'. F.RDA.
FROM THE ISSUANCE OFTI,ES ERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
CITYORDINANCE
D�EMEO To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CE PFOV;EJON,�
IMI
NORL TIN ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINAN
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
LES C/o /4�EIAF I
ADDRESS
L
71-ATINAMEISUBDIVISIONNO, I LOT NO. L D NO,
LID FEE S
PUBLIC . G.T .1 WAY PER OFFICIAL STREET MAP A
U.. P-4 R"
EXISTING _A??Qt PRO ED SWll R.,,j
REQUIRED DEDICATION. IT — =.*=�
METER SIZE I LINE SIZE NO, 01 FIXTURES PRV REQUIRED
YE.A .. 0
REMARKS
OWNERICONTRACTOR RESPONS15LE FOR EROSION CONTROUDRAINAGE
i�iL IL14" I I
OAT
-7
I V-A.IAN.EV U
BH ... LINE OR A.131
N.PECTION
I F..ND
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ES
SERA A EVIEW
SIGN AREA
HEIGHT
COMPLETE XEMPT
ALLOWED PR F SED
ALLOWED PROPOSED
�vll LIA I I v
LOT COVERAGE
REOUIRED SETBACKS tFT.)
PnOPOSEDSETBACKS( FT)
OW
AULO ED PROPOSED
FRONT SIDE REAR
�D
FRONT I UF S E R
a
PARKING LOT
. AREA
F j�TYPEqtf'TTZ
C*-_7_ GO U
I 'Rcou"'p, i<=;t
SPECIAL'N;R CTO'
'50LIFED YES
REMARKS N REO'Dic
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTIO
VA--
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
170
GRADINGIFILL
STAT S RCHARGE
-/,!37
5NG REVIEW FEES
LNG INSPECTION FEE
LANDSCAPING E
op
PLAN CHECK DEPOSIT
PEE IFT
TOTAL AMOUNT DUE
RECEI 799
�Igo3-
HEFE"Y ACKNOWEDGE;�HAATT� HAVT��IEAGTHIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS EOgF'CT AND A. , OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
D"', T1 � El
Dty, .d Fe-- d.
TIOk AND VJ (00 G THE WORK AUTHORIZED THEFEBY. NO PERSON WILL BE EMP OYED
IN VIOLAT ON 0 THE LABOR CODE OF THE STATE OF WASHINGTON RE L ATING TO
FOR INSPECTION
is Icknowledod 1�
WORKMEN , COMPENSATION INSURANCE AND RCW 18�21.
OFF, �cl S SIGN E
(425)
771-0220
ATTENTION
EXTP33
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 GRANTED. UBC SECTION 109
FAX
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