20030003A.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS C'77777176
e- , OWNCI?-
41A Pirvaid~14- _�Ai(fctF5
MAILING ADDRESS
1,4 r
W , 514, X aVV
CITY ZIP TELEPHONE
L WIV Wroo
Y
NAME
ADDRESS
CITY ZIP TELEPHONE
Ic
NAME BLO
xj
nucTiclu
q ADDRESS
#w4
CITY
ZIP
TELEPHONE
00-1-he"
-M
1442-5)qS3-
-
STATE LICENSE NUMBER
EXPIRATION DAT
/01 CE-
PROPERTY TAX ACCOUNT PARCEL No.
3 736-o
-005 - M07
NEW
RESIDENTIAL
X
PLUMBING MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
0 SIGN
REPAIR
GRADING CYDS [3 FENCE X
Fr)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL o F RE SPRINKLER
ROCKERY FIREALARM
OWE OF USE, BUSINESS OR AA' TIV" EXPLAIN:
DJEA1,L)
FOA P414T
C,',1J:0T&t447'1VAt
LPERMIT EXPIRES
USE PERMIT
ZONE '5
NUMBER
JOB SUITE/APT#
ADDRESS '5 �+ r< �� -r VL
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW PerrNt Required
Street Use Pera'A R0q'd
EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT UndwWowd
Wiringroquired
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
0 NS RBWRW YES 13 NO C1
REMARKS,t
OWNERICO JBIRNORIBLROMMONO"I E
0 SIDR SEW= Kim n cum a
- WSR 13M W= AVB INIONAM
ENGINEER1jj REJW
AM MVRMM MW IME
FIRE REVIEWEDLFrH—F re
.6K %" W
0 08 cc
FOR INSP=014 REQUIMMM Ic
VARIANCE OR CU SHORELINE OR ADBili I INSPE 'ON BOND
a
ROD POSTED
JOYES 13NO 11
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED , PROPOSED I ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA PLANNING RE -VIEWED BY DATE
REO'D I PROVIDED I I IL
CHECKED BY 1TYPEff;r
Y(US30N I
ROUP
NUMBER NUMBER OF CRITICALeA-,700 -1 OCCUPANT
OF d I DWELLING AREAS 5V SPECIAL INSPECTION JAREA I
nZ31ce UNITS I I NUMBER = ocn"Imrn - nAn
U
DESCRIBE WORK TO BE DONE IREMARKS
PLAT
,13 Fs2 = �?, t q -7 J"f.
5tiao 0 1 --= 3a 5 sif'
5H at) 0,-1 r 3 le _- f.
HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, ORNMAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISODAYS
PERMIT LIMM I YEAR - PROVIDED WORK 15 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 CITYS ABILITY TO ENFORCE AW ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I NA 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 LOa!4 CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSNrION.M6URANCE AND RCW 18.27.
DATE SIG
PER UBC
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
R INSPECTION
1425)
771-0220
EXT 1333
I
INSPECTION REG'D
Description
State Surcharge
City Surcharge
Plan Chk. Depo
Receipt #
Total Amt. Due
Receipt #
FEE
T pi
T P
pp
tion is not a permit until signed by the
ull"dj
1sor his/her Deputy:
and Fees are paid, and
rec Ila acknowledged Irpepace
provided.
TF VIL I
DATE
It IS'UN(-AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
q
MRR-12-2003 09:42
P. 02
Fab 7 2003 10;00 P.01
pW ZrAACUMAir MAK 1 4 ZUUJ
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS TOTAL P.02
FINAL PROJECT APPROVAL FORM
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