20020977.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER.N&MEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELE HONE
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NAMEp V
ADDRESS V
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CITY ZIP TELEPHONE
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NAME IC13L#
ZIP I TELEPHONE
dtKfE LICENSE -NUMBER EXPIRATION DATE
C CKED BY
PROPERIT IAA ACCOUNI PAMCEEL 140.
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NEW 0 RESIDENTIAL 0 PLUMBING / MECH
COMPLIANCE OR
ADDITION OMMERCIAL
CHANGE OF USE
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(TYPE OF Usf. PUSINESS OR ACTIVrM EXPLAIN:
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO' VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CUREIS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICAl'A ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HERESY 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 CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WnRKMENIIS COMPENSATION INSURANCE AND RCW` 18.27.
(OWNER 0 DATE I
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Street Use Permit Raq'd
EXISTING PROP(
Inspection Required
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REQUIRED DEDICATION_�� FT
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METER SIZE
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YES 13 NO 13
REMARKS
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Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receint
APPLICATION APPROVAL
CALL
FOR INSPECTION
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
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OFFICIAL7S I G N7;, ;U;RE D TE
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771-0220
DATrl
Off 1333
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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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ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE'
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PERWr B# DATE INSPECTED
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:..�'DESCRIPTION OF WORK TO BE INSPEC
A:field, inspection was conducted to determine final compliance with approved plans. FTinal approval
that there are no objections from the above signed Department to the release of
P-ERFORMAriCE BONDS and the granting of:
CT APPROVAL
GRANT FINAL PROM
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
9 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
cl C of CORRECTION NOTICE given to owner/contractor by inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
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TE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNErEINAME OF BUSINESS
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MAILING ADDRESS
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CITY TELEKHONE
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PERMIT EXPIRE /07
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NUMBER
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ADDRESSZ24 )q_a1M,
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
C, 1;7 �$
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Requ:red
EXISTING PROP OSED
Suefit use Porm t Req'd
Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
UnderWound
Wiringroquited 13
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
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F-70.
YES 13 NO 13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY UA I t:
ADDRESS
E R Y DATE
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TELEPHONE
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INSPECTION
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13YES WO
BOND
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SEPA REVIEW
COMPLETE , EXEMPT
0 IV C
EXP 2,cxn.
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PAR EL NO.
(0.2- 7 6 C)
N Ew RESIDENTIAL PLUMBING MECH
COMPLIANCE OR
0 ADDITION OMMERCIAL
CHANGE OF USE
-REMODEL,.. MULTIFAMILY SIGN
�10
FENCE
REPAIR GRADING CYDS 0 ( _ X_FT)
LOT COVERAGE
ALLOWED PR OSED
NA
REQUIRED SETBACKS (FT.1
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
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PARKING LOT
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AREA
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OCCUPANT
GROUP
NUMBER NUMBER OF CRITICALr-Ai
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SPECIALOOSPE81ME
REQUIRED
EIYES
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Descriptl
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FEE
Plan Check
State Surcharge
HE�T SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
PLAN CHECK NO- VESTED DATE,.
0 L 2__ C_
Mechanical
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THIS murr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION[ONTHE PU13UC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SrRATE PERMISSION.
Grading
E�gr. Review
W
IL
r—"-!
PERMrT LIMM IYEAR � PROVIDED WORW*is STARTED wrrHiN mo DAYS,
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
0
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, nS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C11YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY 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-
TION: AND IN DOING THE WORK AUT14ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIPN OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN)p COMPENSATJOMSURANCE AND RCW 18.27.
CALL
FOR INSPECTION
1A135)
771-0220
APPLICATION APPROVAL
ihis application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
OFFICIALS SIGN TURE D TE
�7 I
SIONATA
(OWNER 0
DATE GNED
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AdIED BY DATE'
AtTt*ION
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. UB..C. SECTION 109 PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
04/02 ARE MAKING 5 COPIES
PRESS HARD -YOU
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