20020740.pdfDATE RECEIVED
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PERMIT EXPIRES
ZOE PERMIT
CITY OF EDMONDS ,, NE /Z- Zzvz&
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB 17 3(.-Il /111 1_1f�c_" W_ SUITEIAPT#
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NAME
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FIRE REVIEWED BY
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STATE LICENSE NUMBER I EXPIRATION VARIANCE 08 CU SHORELINE OR ADB# RITPECTION BOND
POSTED
E3YE No I
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE E7PT ALLOWED PROPOSED ALL OPOIE.
Pit
0 0 44('24e6' 0// 00 EXP 0,701
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0 PLUMBING LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
NEW IMECH REAR
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0 REMODEL 0 APARTMENT 0 SIGN REOD I PROVIDED (,,��ENIREVIEWI
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0 REPAIR Y.S [3 ( X FT) REMARK.
DEMOLISH 0 TANK OTHER
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0 OWE OF�E�USINESS OR
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NUMBER
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STORIES REQU LOAD
DESCRIBE WORK TO BE DONE MAS rrt?- L3 j-200 O-A REMA KS
ROGRESS INSPECTIONS PER UBC 108/1FINAL INSPECTION REOD
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I VALUATION $ /4/0� — I
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THIS PEROUTAUTHORIZIESONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
t: Be DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
X
:3 DOMAIN Irma, sioEwaLits, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEFARATEPERMISSION.
2
Mechanical
Grading
Engr. Review
RE MRIAPPLICATION: INDAYS
PERMITILIMITIYEAR-PROVIO 0 WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEa BACK OF PINK PERMIT MR MORE INFORMATION
VaPPLIC ON BEHALF OF 1111 Oil HER SFQU11, HEIII, ASSIGNS AND SU C110 I
ANT' C
Traffic Mitigation
IN INTEREST, AGREES To IN.EMNI1 DEMEN. .. Note HARMLESS T � CITY OF
.1 EDMONDS, WASHIN N. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
DAM ES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
.1 CLAIMS FOR ..
Fire Review
FROM THE I SUANCE F THIS PERMIT ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY RDINANCE PROVISION. -
Lmd7p.H,7�
I HERE ACKNOWLEDGE THAT I HAVE REM THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECr. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGU ING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE LABOR ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTU
WORKMENE SJDM�M ATION INSURANCE AND Dow 18,27.
DATE SIGNED
(425)
1
771-0220
ATTENTION
EXT 1333
IT IS 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. UBG SECTION 109
FAX
10101
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
APPLICATION APPROVAL
This.ppla.flan isam apench-111 signedbythe
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�,ecolpt is acknoviedged In space provided.
F1 I S SIGNATURE DATE
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PINK-OWNER - GOLO�ASSESSOR
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