20010315A.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
7WNER NAMENAME OF BUSINESS
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Q
MAILING ADDRESS
o
CITY zip
ITELEl"011
NAME
ADDRESS
CITY zip
TELEPHONE
NAME
Ane—
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ADDRESS
j'7
0
L. 1
zip
TELEPHONE
31
STATE LICENSE NUMBER
.........
LEGAL DESCRIPTION OF PROPERTY I—IJ11 I" —M IS
4
PROPERTYTAX ACCOUNT PARCEL NO.
r% r% r% n!5 10
E AL
P -GE.T' PLUMBING I MECH
NEW FIE.I.E.TAL
0 ADDITION COMMERCIAL ci COMPL ANCE OR
CHANGE OF USE
ICO]
7
FEMODE APARTMENT C] SIGN
GRADING
REPAIR C3 CYDS 0 FENCE
THER
DEMOLISH 0 TANK 0
ciGARAGE [3 RETA,11,11., WALL
CARPORT GO EFY C] RENEWAL
(TYPE OF USE BUSINFAA A ACTIVITY) EXPLAIN:
-ER
NUMBER
OF
N MIE1101
UM-EF��-
'FiTGAL
CRITICAL
C
OF
STORIES
WELUN
D ELLING
UNITS
AREAS
AREAS
NUMB
NE_
PLAN CHECK NO: 11EITED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS,SIDEWALKS. DRIVEWAYS. MAROUEES.ETC-) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
;APPLICANT ON BEHALF 01 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOR
N NTEREST. AGREES TO INDEMNIFY. DEPEND AND HOL0 HARMLESS THE CITY 0
D TSOFF,CIALS EMPLOYEES,AMD ARECTLYOR INDIRECTLY
E MONDS. WASHINGTON. GZNTS FROM ANYAN
ATEVER NATURE , ARISING D
ALL CLAIMS FOR DAMAGES OFWH
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 8
DEEMEOT FY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
0 MOD' N
OR L-T IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
PERMIT EXPIRES
USE PERMT
ZONE NUlER
70—B r%A ic A / SUITEIA-
1. 1 1 —
LEGAL DESCRIPTION CHEC7 ---
I - I —
LONG
P 'CALS'REETMAP
OFF
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P U 11 RIGHT 01
X'B'
No R I RED E.'CATi-N
EXISTING REGUIRED DEDICATION
E
PROPOSED
lEiICP A—— Q
0
S':' 0,
P.
El
FWAYEI
No OF FIXTURES
PFIV REQUIRED
YES 0 NO 13
RE . MARKS
7
Z
--------------
ENGINEERING MEMO DATED EW..y
rFIRE MEMO GATED REVIEWED BY J1
I OREL
VAR10CE OR CU
ADBI
SHORELINE
SERA REVIEW
EXEMPT
EXP
XP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
tCOMPLITE
LOT COVERAGE
A AL,
LLOWED PROPOSED
REQUIRED SETBACKS (Fl)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UPSIDE REAR
LOT AREA
PLANNING REVIEW By
REMARKS
C O,P
SPECIAL INS PECTCA JAREA LoCURA1,1T
REQUIRED C3 YES AD
REMARK
PRO
is opc,-i or ClDsad, expansion tanks are
requ�red on d hot i�ifer tanks per
e4 eade. EOBO I . .
FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
BUILDING
PLUMBING
(40 - 01b
MECHANICAL
30-06
o
GRADING/FILL
URCHARGE
5, (zz
STORM DRAINAGE FEES
S ENO INSPECTION FEE
F
D
E
E PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE TH HAVE READ THIS APPLICATION. THAI THE INFORMATION
GIVEN IS CORRECT, AND THAT: AM THE O-NEFO A 'T.ORIZED AGENT oF
WITH CITY AN OR THE DULY U
THE OWNER. I AGREE 11 Co'PLY STATE LAWS HE ULATING CONSTRUC
TION, AND IN DOING THE WORK ALT ORIZED THEREBY. NO PERSON LL BE EMPLOYED
WI NO To
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE A' I
WORAMENS CDMPENSAIION INSURANCE AND RCYY 18 27
I DATE SIGAD
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
1 L��
APPLICATION APIPHIUVAL
CALL
I I—, , — " P.", ,
R INSPECTION
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1 S N LIFE I
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771-0220
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MAR 2 6 2001
DEVELOPMENT SErIVjQ!. CTR
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