20020731.pdf4
DATE
L. RECEIV 7
LPERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
"N'C(� ?, NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEPI)T#
ADDRESS ;JU
OVJNE(I NAME E OF BU INEk
6
31
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
AV2, C. MCA
MAUNd-ADDRESS
LID FEE $
IESCP APPIDV$d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Requited
street Use Permit RoWd
ZIP
lnspwwn Required
EXISTING - PROPOSED Sidewalk Required
�TELEPHONE
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REQUIRED DEDICATION- FT underwound
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NAME
METER SIZE LINE SIZIEJ NO. OF FIXTURES PRV REQUIRED
I YES C3 NO C3
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME CBIL #
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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CITY I ZIP ELEPPONE
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IANCE OR CU SHORELINEORADB11 INSPECTION BOND
STATE LICENSE NUMBER EXPIRATIOq DATE CH a
REQ'D I POSTED
13YEs ONO $
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j ME
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED I ALLOWED , PROPOSED
1�3
,
EXP
1:3 NEW RESIDENTIAL XQLUMBIN MECH
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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ADDITION COMMERCIAL C PLI[ANCE OR
CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED BY DATE
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(REMODEL MULTIFAMILY SIGN
REO'D PROVIDED
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RE GRADING F NCE
PAIR CYDS X FT)
REMARKS
OTHER
0 DEMOLISH TANK
3 GARAGE RETAINING WALL F RE SPRINKLER
0 FIRE ALARM
CARPORT ROCKERY
(ME OF USE, BUSINESS OR N:
CHECKED BY OCCUPANT
GR
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION AREA OCCUPANT
STORIES UNITS NUMBER
REQUIRED [3YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 106/FINAL INSPECTION REQ'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
state Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit City Surcharge
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-
PLAN CHECK NO., VESTED DATE
Plumbing 6
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDL-WALIKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
PERMITAPPLICATION: ISO DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee Receipt 4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
PLICATION APPROVAL
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-
I id 11cation Is not a permit unfit signed by the
I
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
BuIldin Ial or his/her Deputy: and Foes are paid. and
IN VIOLATION OF THE LABOR -CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION ec pt Is acknqModged In space pf2ld:6 I,
WORKMENS COMPENSATPfqR_S"C
St�ND RCW 18.27.
OFFIQI SIGNATU I /-
A/
SIG U ER 0 AGENT) D�UE SIGNED
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771-0220
D BY DATE
ATTiNTION 7'
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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1 (�L 11 ... PERMIT EXPIRES 2
CITY OF EDMONDS
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USE PERMIT W3
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CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
15 MkLlkG ADDRESS
LID FEE $
--- TESCP App"rad
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Permit Required
9.2 0,!054� oe
Aw
street Use Parnh 1180
CITY ZIP
EXISTING — PROPOSED Inspection R&qLiW
Sid&wa* Required
ATELEPHONE
V0 k
REQUIRED DEDICATION— FT Undargmund
uIred 13
NAME
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
1
YES [3 NO 13
5
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
NAME COLN
ENGINEERING REVIEWED BY DATE
SS
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FIRE REVIEWED BY DATE
CIV 9 ZIP TELE 'LiONE
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STATE LICENSI% NUMBER EXPIRATIO4 DATE CHE
IANCE OR CLI SHORELINE OR ADS# INSPECTION BOND
REO'D POSTED
[3YEs 0
[13' -A s
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
PR
EXEMPT ALLOWED PROPOSED ALLOWED OPOSED
,
EXP
NEW RESIDENTIAL PLUMBIN MECH
LOT COVERAGE . REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
LIANCE OR
ADDITION COMMERCIAL El CHANGE 00 USE'
PARKING LOT AREA PLANNING REVIEWED BY DATE
PROVIDED
9L
y Mo L muLnFAmiLy 0
RE DE SIGN
RECrD
R GRADING i FENCE
EPAIR CYDS X FT)
REMARKS
DEMOLISH 0 TANK OTHER
o GARAGE RETAININGWALL F RE SPRINKLER
CARPORT ROCKE El FIRE ALARM
__RY
(ME OF USE. BUSINESS 0 N:
CHECkEDBY jTYfAFjCjOM1ON OCCUPA
GROUP,;
VL
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NUMBER NUMBER OF CRITICAL
OF AREAS
DWELLING
SPECIAL INSPECTION JAREA OCCUPANT Z—
LOAD
STORIES UNITS NUMBER
REQUIRED
YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD.
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eko 4) a V—
VALUATIOW----]
ell to
$
Description
FEE
Description
FEE.
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AVTHOR17ES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t:
gr. Review
I
PERMIT APPILICAT14. ;1130�*VS
�
IL PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAVS
Engr. Inspection
SEE RACK OF PINK PERMIT fOR MORE INFORMATION
it
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
IN INTEREiW AGREES TO INDEMNIF% DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, IT$ OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapainsp. Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Receipt 4
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
A131 L
PLICATION APPROVA
GWEN 18 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-
t
CALL Thl a leation Is not a permit unfil sIgned by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, 'hO PERSON WILL BE EMPLOYED
BuIldIn let or hWher Deputy: and Fees are paid, and
1(.4,
IN VIOLATION OF THE LASO PDE OF THE STATE OF WASHINGTON RELATING TO
BX
FOR INSPECTION oc Pt Is acknqWodged In space proA�0jL,,
WORKMENS COMPENSA 10.27.
_^NSqANCE AND RCW___
A�
OFFIq_ AIGNATURf/
SIG 6J WNER 04fAGENT) D5E SIGNED
1A#3 )
25
771-0220 —D
B Y DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES.,