20030001.pdfDATE RECEIVED FPERMIT EXPIRES
CITY OF EDMONDS
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USE PERMIT r;�O—
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CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS 0 it 1�� I a
OWNER NAMEINAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. J LID NO.
MAILING ADDRESS
LID FEE S
TESCIP APP(OVDd
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW ParrrAt Required
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1.6
Street Use Permit Req'd
—
CITY �!lp TELEPHONE
Inspection Required
EXISTING — PROPOSED Skiwalk Requited
REQUIRED DEDICATION— FT UnderWound
Wiring requkW 13
NAME
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
YES13 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE
NAME C'BL #
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STATE LICENSE NUMBER CHECM BY
REO'D POSTED
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13YES 13NO
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SEPA REVIEW SIGN AREA HEIGHT
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REMARKS
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FIRE ALARM
CARPORT ROCKERY
(TYPE OF USE. BUSINESS-IDFI ACTFVJM EXPLAIN:
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CHECKED BY TYPE T CTION CODE OCCUPANT
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
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REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION RECrD
9
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing zin
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONMUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, ORNIEWAYS, MARQUEES. ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
t:
Engr. Review
PERMITAPPLICATION: 180 DAYS
PERMIT UMM 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
PERMIT NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS SHALL
Landscapeinsp. Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2,_ INOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
#
Recording Fee II Receipt
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICNrION; THAT THE INFORMATION
APPLICATION 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-
CALL This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Oftlal or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMENS COMPEN?��CW�JrCE AND RCW 18,27.
OFFICIALS SIGN TURE DATE
(OWNE AGENT) DATE SIGNED
BIG vro#
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142 17
— 7_ /:10&
771-0220
REtEAsED BY IIATE
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 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL -PROJECT APPROVAL FORM
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RECEIVED
7 PERMIT EXPIRES a
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USE PERMIT c7o o
CITY OF EDMONDS ZONE NUMBER
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS q10 od lew
OWNER NAMEAME OF BUSINESS
A A A PLAT NAME/SLIBDIVISION NO, LOT NO. J LID NO.
MAILING ADDRESS
CITY
NAME
CITY ZIP
NAME
ADDRESSI
Crr� ZIP TELEPHONE
STATE LICENSE NUMBER
-11 (�o
Cal. #
lool
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No.
I
I Mio 411(?490
NEW
WORESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAI R
GRADING
CYDS
DEMOLISH
TANK
[3 GARAGE
o RETAINING WALL
CARPORT
ROCKERY
I[TYPE OF USE. BUSINESSIOR ACTIV EXPLAIN:
NUMBER OF
.NUMBER
.OF
STORIES
DWELLING
UNITS
E WORK TO BE DONE
t
WPLUMBING/mECH
COMPLIANCE OR
1:1 CHANGE OF USE
0 SIGN
[3 FENCE
X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW PerrrAt Required
Sum Use Peffrift RoWd
EXISTING — PROPOSED
Inspection Floquired
Sidrivalk Required
REQUIRED DEDICATION— Fr
Undsaound
WIMIlmqulmd
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
PURSUANT To 01.<n,
FIRE REVIEWED SYS CE SHUTOW
Im"L BE INS
LED ON T11E,
LIMMMAS 7M'r01rn2
VARIANCE OR CU
SHORELINE —ORADS#
IN
BOND
REO'D
1'[3YEs
POSTED
ONO
1$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROP
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E REAR
718 ECDC
FRONT LIRSIDE REAR
A
L)RE
9 -30-020
FrrIT
PARKING
T
'j -_ FRW E
RECID I PR61DEDilil"R
TIM LED MAR
REMARKS
CHECKED BY jTYPEjFfO TION CODE OCCUPANT
CRITICAL A !Z 1 aa GROUP A
AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMBER REQUIRED [:] YES LOAD
HEAT SOURCE GLAZING % I LOT SLOPE
PLAN CHECK NO: I VEFT_EO DATE
THS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTV ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, ORIVEWAVS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
SEE BACK.OF PINK PERMIT FOR MORE INFORUATION
*APPLICANT. ON BEHALF OF HIS ON HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
1:0140NDS, WASHINGTON, 98 OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIIAS 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 LUT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACWWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRE" 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 AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAB90-CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENS&rfflW4N9UWCE AND RCW 18.27.
iAGE DATE SIGNED
Z�'_ I I — ) . C)
REMARKa I
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D
Description
FEE
Description
FEE
Plan Check
State Surcharge
S,
Building Permit
City Surcharge
Plumbing
40
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapainsp.
Total Amt. Duo
Recording Fee
Receipt #
CALL
FOR INSPECTION
IA95)
771 -0220
APPLICATION APPROVAL
This applicallon Is not a permit unW signed by the
Building Officiall or hi0or Deputy: and Fees are padl, and
receipt 13 acknowtodged In space provided.
OFFICIALS SIGN URE D TE
RELEASED BY OATE
ATTENTION Off 1 33
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-ASSESISOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN, ACCOUNTING