20020434.pdfrj
OAT
___L
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
j5.11;�NAIAMI OF BUSINESS
J�+AI20_—
MAILING ADDRESS
..I, ZIP ITEL11HONE
�Jjm om d
NAME
I�Gf
ADDRESS
K5-0 I \/\) &'trvyk
CITY "P ITIL PHONE
'fq 117), ') — - , LL / -,;-I -
5z
1 1
PERMIT EXPIRES
1E PERMIT
ONE NUMBER
00 V - SUITSIAPTT
FLAT NAMEISUBDiVISION NO,
T No.
LID NO,
U. FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
er
13
EXISTING — PROPOSED
13
13
REQUIRED DEDICATION— FT —
METER SIZE
LINE 1111
PRV REQUIRED
I
(ES C3 No E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
A DRESS
0
110 LHTV ?I
FIRE REVIEWED BY DATE
TELEPHONE
K" �Fl
zo
-
STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTI N
REDO
I BOND
POS TED
/0-,
)'CKE
I � W
.3YES [3 NO
r
ULU ALICL@oi tob';
9EFA REVIEW
-E.1T
SIGN AREA
ALLOWED I..I.BDD
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO F
S;7_
XP I
,
,
REBID NTIAL
EW C-CH,
L U 'IN ICH
Cov RAGE
T CO' ""0
LOT COV A
0
AL 0 "ED
ALLOWED PROPOSED
P
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LJRSIDE BEAR
0 MP LAN E 0
ADDITION �rCOMMERCIAIL ri C MPLMNCE OR
A N E U
CHANGE OF USE
I
REMODEL APARTMENT M SIGN
tGN
RKNG
R
RECT,
0
PRO
PROVIDED
I
LOT �REA
PLANNING REVIEWED BY DATE
ENC.
[3 FENCE
REPAIR Ej GRADING CIDS I _ X PIT
X
IT EM ARKS
IPA
n DEMOLISH 0 TANK OTHER
GARAGET RETAINING WALL 0 RENEWAL
CARPOS ROOKERY EW
(TYPE OF USE. BUSINESS OR ACTIVITYl EXPLAIN:
QED CE-7
CHECKED By
T ION
C171
OCCUPANT
GROUP -t
FUDCAL
c I
READ
...
u ER
SPECTIALEINSPECTOR
E 'A C
EQU R JAREA
L 'NEF
RE ED
our. [:I YES
i Y
OCCU PA NT
LOAD
DESCRIBE WORK TO BE DON'
REMARKS
PRO.IRIESISINSPIECTIO.. PER EIC 110811INAL INSPECTION RE470
pim
LALUATION $
Description
Plan Check
HEAT SOURCE ILALINI I
U
L11 1-11 1
'L'
13u,ld,ng
Building
TED A T E
umbing
achanical
MIT 0 V W T
.as O-K
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK-ro
ON HE P U -C
I: BE DONE OR PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 ID W L L "`E
3 MAIN JCUS13S, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATEPEnMiSSION.
Engr. Review
PERMITAPPLICATI N; ISOIDAYS
PERMIT UMIT I YEAR 0 WORK IS STARTED WITHIN 180 DAYS
T
SEE BACK i FIRNON'PIDERMIT FOR MORE INFORMATION
Engr. Inspection
B C-E...
'APPLICANTF ON 111ALF 01 HIS OR 1111 SIOU11, 1111111, ASSIGNS AND IUCIEIGII
I - Try OF
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
Fire Review
EDMONDS, WASHINGTON. ITS OFFICALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE 'SSUANC OF THIS PERMIT. ISSUANCE OF THIS, PERMIT SHALL NOT BE
Fire Inspection
To . AN CITY OF IN
DEEMED FY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CRY ORDINANCE
Me" One, NCE PNG�'S�.N
..a LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY NA
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TION; AND IN DOING THE UT.O.L!ED THERE-. No PER. N WILL BE EMPLOYED
IN VIOLAT C E OF THE STATE OF WASHINGTON RELATING TO
ION OF THE;WN"
FOR INSPECTION
I BU ,
WOR�MEN N INSU NCE AND RCW 18.27,
BIG URE low ED 0 1
(425)
1
r
771-0220
AVONTION
EXT 1333
IT 19-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
10101
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chit Deposit
Receipt #
TotalAmountDUS
Receipt #
JCATION APPROVAL
avi- Isnot a emm unto,lgnod bVIre
I ., hl�ft, D—W md F — DiIIII. �.d
YELLOW .'INSPtCT
GOLD - ASSESSOR
z
0
d
0
0 m
C
m
0
80
C
M
M Z
m Th
0
0
C m
ch
CO
m 0
z
z
z
9
0
m
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
SPECIAL INSPECTION
cl m
M
0
0
C,
XM
mz�
C,
Irl m
0 as
0,—
c
= ca
M C)
z
.'IT
M
z
z
m