20020631.pdfDATE RECEIVED
--mmaymommonei 21 1) [PERMIT EX
USE ERMIT
CITY OF EDMONDS ZONE NPUMBER
CONSTROCTION PERMIT APPLICATION JOB SURE/A
ADDRESS
ME OF EILISSRES —7
F-W ;EN 011A.N;�I.A
'�D FEE S
ADDRESS FLAT NAMEISUDDIVISION NO. L D NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TES-FZP1d
TELEP14ONE
ZIP EXISTING — PROPOSED
13
... LIMED DEDICATION —
NAME R SIZE DLINJS ZE �_ I NO. OF FIXTURES PIV IIQUIRED
, V,
pe r ,If ConneetorS YES 13 ,,, C3
75-67. 1 -S A
Is 0 N -,Cq!Z!OLfDRAINA iE
CITY ZIP TELEPHONE
NAME ICBLI
_ ( �v ro <x-o ENQINE..IN.II.V�EWEGSY DATE
ADDRESS
GieRe 0-
FIRE REVIEWED 11 DATE
TELEPHONE
IF
�'P�
�61,jnu_ QQ _)VIA
M
STATE LICENSE NUMBER EXPIRATION,DAIE C Y No
State & In �IED
ILabor
I
PROPERTY TAX ACCOUNT RANGE C SERA-" 84N.A"A.
m =E.Pj ALLOWED PROPOGID ALLOWED PROPOSED
— C-) AA t EXP I I
G FT.
HE LOT COVERAGE REQUIRED SETBACKS PROPOS SETBACKS (FT)
NEW Ej'�E.KIENTIM, .. IN. I MECH
J2_1L
ALLOWED PROPOSED FRONT SIDE REAR FRONT R SIDE HEAR
B,
C MPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
PARKING lE.T" REA
PLANNING REVIEWED BY DATE
ENIODEL MULTIFAMILY SIGN REDD
;2_;� PROVIDED
REPAIR 0 GRADING PENCE I
CYOS X — FT) REMARKS
rl DEMOLISH TANK OTHER
CAR Al SPRINKLER
Ei GARAGE FLETAININGWALL Fs
CAR P,
CARPORT ROOKERY REALARM
F,R
P a OF USE, BUSINESS OR IVITY) EXPLAIN:
CHECKED BY C
RL- R..UPANTg,
ITYPEUITL G
T14JOW UP
NUMBER CRITICAL
OF AREAS SPECIAL INSPECTION OCCUPANT
S TOISES R C] Y_ JAFIEA
TORIES NUMBER SQUIRED LOAD
DESCRIBE WORk TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC I08/FINAL INSPECTION REO'D
N-(
0
Q(-Nrl 0
$
Description
FEE Description FEE
4D,,
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOP
'lop, %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
.
Mechanical
THIS PERMIT AUTHORIZES ONLY THE W ORK NOTED. '.Is PERMIT COVERS WORK TO
Be DONE BN PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON REPUBLIC
DOMAIN I
Grading
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL ED
a BIDS
SEPARATE PERMISSION.
PERMIT APPLICATION: too DAYS
Engr. Review
PERMIT LIMIT, I YEAR � PROVIDED Won IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
�APPUCANT. ON BEHALF OF HIS 08 HER SPOUSE, HEIRS ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS T146 CITY OF
Fire Review
Plan Chlk. Deposit
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspecti IT
Recolpt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
THE ISSUANCE OF THIS PERMIT SSUANC� OF THIS PERMIT SHALL NOT BE
UFROM
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE.
Landscapeinsp.
Total Amt. Due
'OR LIMIT IN ANY WAY THE CITYS ABILITY To ENF.RCE A. ORDINANCE PROV'SJON�
—
Recording Fee
,1.EFIESY ACKNOWLEDGE THAT. HAVE HEAD THIS AIRI.I.-I.R; THAT THE INIONVA1101.
N
—
APPLICATION APPROVAL
ER, 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
This applicahs, is no's ps""' shtil sig"ad by Ma
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
OF TH
IN VIOLATION OF THE LABO FATE OF WASHINGTON RELATING TO
Ty��&ODI OF THE
WORKMEIS COMPENSA WEIRD W IS.,
T)*&O
W
FOR INSPECTION
B,h Lila Official ot hilft, O.P.sy: rd
IPtJkshWI.d9sd1n sp ... rs.�Jdsd
OFFICIALS 2,GNAZE
6�
771-0220
- I , /
ABED BY DATE 7
ATTENTION
E)ff 1333
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
ORGINAL.F$LE YELLOW -INSPECTOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES
PINK -OWNER GOLD ASSESSOR
GREEN ACCOUNTING
z
X
C: 1111 4 1
MO
0
80
a
3:171
ITT
E4
0
ITT 111
a V;
0
0
C Go
M Co
In C.)
V
z
to
z
0
--I
0
in
Ma
0
MT
jo-I
0 "n
n
-4
x E 'i
m m
a
0
C
c (4
M
Z
74
z
V
0)
z
9
55
m