20020620.pdfIUATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME
PERMIT EXPIRES
rU—SE
ZONE ERMIT
NUMBER qV,52
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JOB sUITE/APT#
ADDII'Iqq_�l _b)M;9,4JJ)
PLAT NAMEISUBDIVISION NO.
LI6 NO. j
10 FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— Fr
Wuln,, I.—d 13
METER SIZE
LINE S��
PRV REQUIRED
C
I
YES E3 No C3
1
REMARKS
OWNER/CONTRACTOR RESPONPISLE FOR FROSIO?
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R
B r. a "60 Y. H'i 6 CISL '� q5 7
FIRE REVIEWED BY DATE
ZIP
TELEPHONE
STAFE UCENSE NUMBER
VARIANCE OR CU
SHORELINE OR ADS*
INSPECTION
REOG
OYES Yj�N'0
BOND
POSTE
PROPERTY TAX ACCOUNT PARCEL NO.
�%2 -7, 0-,',1 q 00
-?q 61-
?q 00
REVIEW
COMPLETE 1 11
EXP
SIGN AREA
ALLOWED PROPOSED
ALLOWED PROPOSED
I
13E "n
13 NEW 1E IDE AL PLUMBING MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SMACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT US SIDE REAR
[3 AUDIT ME.C_L [3 C MPLIANCE OR
ION .. CHANGE OF USE
RTJ
0 REMODEL A A� . NT 0 SIGN
Afa 1]� �Al
1V0 6#AA&e
PASKING&I
IOTAIIA
PLANNING REVIEWED BY DATE 15^ /IT
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0 REPAIR 0 GRADING CYGG 0 1 X Fn
0 DEMOUSH TANK OTHER
RE)=._ 7
r3 GARAGS FIETAINING WALL
CARPO 13 ROCKERY 0 RENEWAL
T
OWE OF USE, BUSINESS OR ACTIVBY) EXPLAIN:
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CIRECIED try
I OF CONS UCTION
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OC UPANT
CUP
NUMBER
OF
STORIES
0
NUMBER F_
OWELLING
UNITS
R ITICA
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AREAS qq
NUMBER
11143%INISPECT01 JAREA
RECR'm [:] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DON.
.REMA KS I I
PROGRESS INSPECTIONS PER UBC 1081FINAL IN=ON RE470
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I u� exs
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FEE
Plan
HEAT SOURCE GLAZING %
I
LOT SLOPE %
I
Building
But
PLAN CHECM
TEED.AT
rChock
Plumbing
Mechanical
Mechanical
IT
THIS PERMIT AM DBMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
2 To W LL U E
:I DOUNN (CUROS. SIDEWALKS. DRIVEWAYS MROUEES, ETC.) WILL REQUIRE
Engr. Review
5-0
city surcharge
L SEPARUITEPERUiSSION.
RE MITAPPLICATION: 180DAYS
LIMIT I YEAR PROVIO D WORK IS STARTED WITHIN 180 DAYS
PERMIT -
:13ACK OF PINK PERMIT FOR MORE INFORMATION
SEE
Engr. Inspection
State Surcharge
-APPUCANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS ASSIGNS AND SLICrESORS
Traffic Mitigation
Plan Chit Deposit
IN INTEREST. AGREES To INDEMNII. DEFEND AND HOLD HARMLESS THE ,,, —
EDMONDS' WASHINGTON, US OFFICIALS, EMPLOYEES, AND AGENTS MOM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARMING DIRECTLY OR INDIRECTLY
Fire Review
Receipt #
Fire inspection
Total Amount Due
FROM THE ISSUANCE OF THIS PERMIT. JSSUANC� OF THIS PERMIT SHALL NOT 11
M WOR
DEEMLEDITO MODIFY. WAIVE OR BE UCE ANY REQUIRE ENT OF MY C1 DINANCE
NOR IM IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapeinsp.
Receipt #
0 ION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI N; THAT INFORMAT 'ON
OF
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
C
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This applicislon is not a prmit until signod by the
LTHE
ED EM PLOYCD
TION; Alto IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE
LA
N OF LABO CODE OF THE STATE OF WASHINGTON RELATING TO
IN VIOLATIO THE
j
FOR INSPECTION
In dft Chid.] , Insih., Dspsy: nd F slu pilid. tind
a I
receipt is ack—lodged In spas, Inmided.
WORKMEN'S COMPENSATION INSURANCE AND ACW 11127.
(425)
DATE
"rMn10
)ATE SIGNED
_ 7 _ 0_
771-0220
f)'Q
R DATE
—
_
AtTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-022 ORIGINAL FILE YELLOW � INSPECT
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK . OWNER GOLD . ASSESSOR
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