20030023.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Walter Poiroer
MAILING ADDRESS
20116 80th Avenue W
CITY ZIP TELEPHONE
Edmonds 98026;� 425-771-9597
NAME
ADDRESS
CITY ZIP [TELEPHONE
NAME
CBL#
All Cl-A.mate Heating & A/C
T!
516.3
ADDRESS
14715 N.E. 95th Unit B
CITY ZIP
TELEPHONE
Redmond 98052
1 425-746-3077
STATE LICENSE NUMBER EXPIRATION DATE
BY
ALLCLHAOOOCB
2-24-04
_9
PROPERTY TAX ACCOUNT PARCEL NO.
C)o q.3 17- D D 6 49 1 go 2-
NEW RESIDENTIAL
PLUMBING/MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
REPAIR GRADING
FENCE
CYDS
X FT)
DEMOLISH TANK
OTHER
GARAGE RETAININGWALL
0 FIRE SPRINKLER
CARPORT ROCKERY
(TYPE OF USE. BUSINESS OR ACTN" EXPLAIN:
—FIREALARM
_ gas line to kitchen range
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
run gas line to kitchen range
HEAT SOURCE I GLAZING % I LOT SLOPE7
PLAN CHECK NO: I VESTED DATE
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.
PERMIll'APPILICATION: 150 DAYS
ERMIT LIMIIP I YEAR - PROVIDED WORK IS STARTED WITHIN ISO 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 PERMrr. 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 ABIUTY 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 DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (OWNER 0 DATE SIGNED
/-/-3 03
I
PERMIT EXPIRES 1
USE PERMIT
ZONE NUMBER
JOB
ADDRESS SUITE/APT#
20116 80th Avenue W
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO..
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appl=.
W ps. R
EXISTING — PROPOSED—
Str
Inspection Reqoked
Slow.. R.,Vd
REQUIRED DEDICATION— FT
Underground
- —1-7—
Wiring required cl
METER SIZE
LINE SIZT
OF FIXTURES
PRV REQUIRED
I
YES E3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
REVIEWED
BE ACCEPTED
FIRE REVIEWED BY
DATE
rL
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
I REO'D POSTED
13YEs 13NOis
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED . PROPnqFn I PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
z
PARKING I LOT AREA I PLANNING REVIEWED BY DATE I !I
REQ`D I PROVIDED 06
REMARKS
CHECKED BY ITY ONSTRUCTIO'N CqW OCCUPANT
GROUP
SPECIAL INSPECT10N REA OCCUPANT
:)N AR
7 LOAD
REQUIRED [:] YES
HFMARKS 2
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REQ'D 19
DeacriptIon
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
EXT 1 33
FEE DescriptIon FEE
State Surcharge
City Surcharge 1143 —
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # 002
APFUMCATIONAPP 11"All
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
— receipt Is acknovAedged In space provided.
I S IGNAJURE ATE
IT IS UNLAWFUL 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
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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