20020990.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNSP�"E/NAME OF BUS "ESS
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MAILING ADDRESS
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CITY ZIP 1TfLEPHONE
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CITY ZIP TELEPHONE
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NAME ICBLN
ADDRESS
TELEPHONE
STATE LICENSE NUMBER
EXPIRATION DATE
C��AED BY
IROURTY T ACC%JNI-PARCEL
NO.
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11 NEW
RESIDENTIAL
PLUMBING I MECH
ADDITION
3
COMMERCIAL
COMPLIANCE OR
13
X
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
0 GRADING
FENCE
CYDS
( x FT)
E] DEMOLISH
[3 TANK
El 077HER
GARAGE
I RETAINING WALL
11
o F:RE SPRINKLER
CARPORT
ROCKERY
F RE ALARM
(TYPE Of 4PE, BUSINESS OR ACTIVITY) EXPLAIN:
/V/0-1 .7 a
NUMBER
OF
NUMBER OF
DWELLING
A11,01-
RITICALfWIVa�<
AREAS
STORIES
UNITS
NUMBEF11-
AOA-7A
DESCRIBE WORK TO BE DONE
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H9AT SOURCE (10ONG % LOT SLOPE %
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P - CHECK NQ—.' 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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
FERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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, 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 CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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 DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIOJF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
S I
WORKMEN'S MPENSATIOARfURANCE AND RCW 18.27.
DATE PIONED
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PERMIT EXPIRES
USE PERMIT
ZONEC141
NUMBER
JOB
ADDRESS
SUITE/A"#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP 'Oved
AW PsfM"'R.,.,.
Street Use Peffnit Req'd
EXISTING PROPOSED
Inspection Required
SIdowL]k Required 13
REQUIRED DEDICATION FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF
FIXTURES
PRV REQUIRED
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YES E3 N 0
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING
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NCE OR RE POSTED
V%— YES c&'NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOW61) , PROPOSED
>Ns IEXP 24M
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
Ar,
PARKING LOT AREA I PLANNING REVIEWED BY DATE
RECID I PROVIDED av 0�mz
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REMARKS
'H C 0 TRUCTION PANT
TYPE 9 E OCCU
GROUP
SPECIAL INSRECTION OCCUPANT
REQUIRE LOAD
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REQ'O
VALUATION
Description
FEE
Description
FEE
Plan Check
. A -Tee?
State Surcharge
4..6v
Building Permit
C;i-co-
City Surcharge
.6_0�er
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
A10"2-
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
7 ele
Recording Fee
Receipt #
A ////
CALL
FOR INSPECTION
(425)
771 -0220
Off 1333
APPLICATION APPROVAL
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.
OFN SI URE DATE
RPELD BY
All/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I 44��� iW/
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 'ORIGINAL - FILE YELLOW - INSPEC-?�
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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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNEPtjAME,1NAME OF BUSINESS
64 �EWM,&?dl
MAILING ADDRESS
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CITY ZIP
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NAME
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ADD E V --I
CITY qr ZIP TELEPHONE
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NAME ICBLN
ADDRESS
TELEPHONE
STATE LICENSE NUMBER
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CWKED BY
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)ROPERTYT ACCO.VN-LPARCELNO.
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
X
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
X_FI)
DEMOLISH
TANK
OTHER
GA`RPoRT
0
RETAININGWALL
0
FIRE SPRINKLER
CMAGE
ROCKERY -
F RE ALARM_
(TYPE OF. USE, BUSINESS OR ACTIV" EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL"I'Vier<
AREAS
STORIES
UNITS
NUMBERrA 0
DESCRIBE WORK TO BE DONE
7466k I -S 1%V4&,eb y1ty- e- NLA) //
H�AT SOURCE GLAZING % LOT SLOPE %
PLMC VESTED DATE
THIS PERMrr AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONW. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT A45&1o�. lied ohs
PERMIT LIMIR 1 YEAR - PROVIDED WORK IS START01wITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
FPERMIT
EXPIRES
USE PERMIT
ZO.ECW, NUMBER
JOB V
ADDRESS is (.v ivot
SUITE/APT#
PLAT NAME/SLIBDIVISION NO.
-Y
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPF ad
RW Permit Rov
Street Use P:q":;ed
an Req'd
EXISTING PROPOSED
inspection Required
Sidewalk Required
[3
13
REQUIRED DEDICATION FT
undergroland
winno roquirsol
CI
METER SIZE
LINE SIZE
NO. OF FIXTURES _
PRV REQUIRED
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YEsI3 NO
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROsr6N CONTROWDRAINAGE
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REVIEWED BY DATE
Fr R I E( LSD
17
VA7TI
NCE OR�U
SPORELINEORADBM
INSPECTION
BOND
1A I
70M I W
REC&'
I 13YES
POSTED
1$
q^ _
NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLIZIC EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
EXP 24M
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
AiA
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REQ'D
PROVIDED
!E
W,
REMARKS Aft Aft NOR AND lesm�
C C TYPE LICTION CODE OCCUPANT
GROUP
SPECIAL INSPECTION I OCCUPANT
REQUIRED YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
$AYLJI) —I--
7r,K
Description FEE Description FEE
Plan Check
zffMf
—_
State Surcharge
!
Building Permit
City Syrcharge
Plumbing
01
Mechanical
Grading
�E Review
,pgr.
Engr. Inspection
R S
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit,
0 F
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
D
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
17)A jq
L Y
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
BE
PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS
Landscapelnsp.
Total Amt. Due
9/
ICE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
I
-
Recording Fee
Receipt ff
'N
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
APPLICATION APPROVAL
I
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
OF
F
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT 1]
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
Y 0
IN NG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TION; AND 11
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATI F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
of
FOR INSPECTION
receipt Is acknowledged In space provided.
OFflICI SI 7AUFE DATE
WORKMEN'S MPENSATWURANCE AND ROW 18.27.
8 h
(425)
SIG
DATE ?IGNED
MLM= 1/0/7" Z, j 771-0220 RELEASED BY DATE
k&ENMON 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- ISPEC �Rl .1
ORIGINAL - FILE YELLOW - INSPEC 7,W
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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