20030025.pdfUW
DATE RECEIVED
CITY OF EDMONDS '
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
— X E:/-/, y H011A
MAICINd ADDRESS
7a/� 07-F_41- tj�t
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP TELEPHONE
NAME Al
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPMW
MY Permit Requited
Permit RW
EXISTING — PROPOSED
Wipecdon Required
Sidewalk Required
REQUIRED DEDICATION— Fr
underground
Wirtingrequired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES C3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
NEW
RESIDENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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ALARM
CARPORT
ROOKERY
FIRE
OWE OF USE. BUSINESS LAIN:
NUMBER
OF
NUMBER OF
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CRITICAL
AREAS
/VV
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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SIGN AREA HEIGHT
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WMARKS:
PROGRESS INSPECTIONS PER UBC 1101111FINAL INSPECTION REG'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOUR!�_7 GLAZING % LOT SLOPE %
Building Perm . it
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
e 2-0- sip
Mechanical
THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
I=- SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT UMM 1 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
EDMONDS, WASHINWON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due 1
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; 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 will signed by the
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or hlsfhor Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknovilodged In space provided.
WORKMENS C
'9"SATION INSURANCE AND RCW 18.27.
OFFICIALS S)GNATUAE DATf:
SIGNAT 0 DATE SIPNED
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771-0220
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RELEASED BY /DAT)f
9NTION
M 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 YELLON-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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RECEiVtO'
PERMITEXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
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2bN 1 03
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JOB RE SUITE/APT#
ADD SS2I� �T
OWNER NAME/NAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID_ FEE S
MAICINd ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
7ESCP APPMV*d
RW ftrwA RaWked
Sbvet Us* PaIMN R-q'd
Inspection RequiNd
Wows* PAIqUlmd
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Wking reqWrod 13
ZIP
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TELEPHONE
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NAME
METER SIZE
LINE SIZE
I
I NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR
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CITY ZIP
TELEPHONE
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ENGIN RING DATE
ADDRE33
FIRE REVIEWED BY DATE
CITY ZIP
TELEPHONE
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SHORELINE OR ADS#
INSPE ION
BOND
I
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
E07
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113YE's 13NOis
POSTED
SEPA REVIEV*& am HEIGHT
COMPLETE X I PIWEWPMU AWED PROPOSED
1 1 qm S� I
PROPEY,W,X�X; ffOUNI,,PARCEL NO.
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RESIDENTIAL PLUMBING/MECH
NEVI A
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEC 0 muLnFAMILY SIGN
GRADING CYOS FENCE
0 REPAIR I X_Fn
_
F&,o OTHER
0 DiMOUSH TANK
[3 "LAGE RE-rAININ&OLt: -b FIRE SPRINKLER
CARPORT ROOKERY FIREALARM_
I(TYPE OF USE, BUSINESS A LAIN:
NUMBER NUMBER OF CRITICAL
'OF DWELLING AREAS
STORIES UNITS NUMBER
:'DESCRIBE WORK TO BE DONE
L�o2ld& itlet-e)(
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
VMS PERMIT AUTHORCM8 ONLY THE WORK NOTED. THIS PIUMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CUR88, SIDEWALKS, DRIVIEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t:
PERmrrAPPucATio4L- isoiDAys
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SM BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESIORS
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 DIRECTIlt OR INDIRECTLY
FROM THE ISSUANCE OF 7.rHIS 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 THO CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HERESY ACKNOWLEDGE I HAVE READ THIS APPLICATION; THAT THE INFORMATION
0114EN IS CORRECT' AND 'AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO CO W WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE W20 AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABO%CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS Cy"SATION I SURANCE AND RCW 18.27.
Ila TDNTE SIONED
71 1,4 ;2,,
LOT C
ALLOWED
- I
PARKING LOT
REO'D I PROVIDED I
fSETBACKS (Fr.)
L/.R SIDE REAR I a I
BY DATE
CHECKED BY OCCUPANT�
TyPVVM GROUP *
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [3YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08MINAL INSPECTION
VALUATION
FEE Description FEE
1AIL 61" State Surcharge
Building Permit City Surcharge
Sf
Plumbing 2o
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscape Insp. Total Amt. Due If
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0
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Recording Fee
Receipt #
APP
CATION APPROVAL
CALL
This application Is not a permit unfit signed by the
Building Official or hisftf Deputy: and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged in space provided.
IIAO
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DATY
OFFICIALS B)ONATU)IIE &
A
4614
1
771-0220
D T
RELEASED BY DATEF
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 -INSPECT
PINK -OWNER GOLD-ASSESSO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
134/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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