20030057.pdfn
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
NAME
ADDRESS
ZIP I TELEPHONE
ZIP
STATE LICENSE NUMBER
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CBL #
ELEPHONE
EXPIR�AON DATE
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NEW
RESIDENTIAL
PLUMBING VECH
ADDITION
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COMPLIANCE
CHANGE OF USE
EMODEL
MULTIFAMILY
0 SIGN
REPAIR
GRADING
CYDS
[3 FENCE
( — X—FT)
DEMOLISH
0 TANK
1:1 OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
0 FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTM EXPLAIN:
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a OF DWELL NG AREAS A
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DESCRIBE WORK TO BE DONE
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USE PERMIT
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PLAT NAME/SUBDIVISION NO.
NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved
RW Permit Required
Street Use Permit Reqd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
UndsWound
Witing requirod
METER SIZE
LINE SIZTO.
OF FIXTURES
PRV REQUIRED
I
YES13 NO 1:3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
11 R INNOR
"ADS#INSPECTION
REQ'D
PBOND
OSTED
YES
ONO
$
BEIRA REVIEW
SIGN AREA '
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
A/e
6"i,
PARKING
LOT AREA
PLANNING REVIEWED BY DATE f9
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CHECKED BY
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OCCUPANT
GROUP 11
SPECIAL INSPECTICYN JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REQ'D
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Lmaldk_a"�7 Description
FEE
Description
FEE
—r4 1,.,.,J_ At, ew- A&A4, -CP tA.1._;-f Plan Check
State Surcharge
HEAT SOURCE NG % LOT SLOPE % 6uilding Permit
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC Grading
:1 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMITAPPILICATION: 180DAYS
916 PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
City Surcharge
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'APPLICAtg ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
x EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Inspection
Receipt #
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IFire
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
'ap.
!31 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee
ecelpt #
I HERE13Y 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 CrTY AND STATE LAWS REGULATING CONSTRLIC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WQRAAkL HORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF TH�BQILP DISNOF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPOS��
.URAN)E AND RCW 18.27.
IA GNAT DATE
____IN
SIG!,IATURE (jER fR A
DATE: SIGNED
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771-0220
ATTENTION
EXT 1333
R E D DATE
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IT IS UNLAWFUL TO USE OR OCCUP UILDINIG OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE A PROVAL OR A CERTIFI- ORIGINAL -FILE YELLC(V-INSPfCTC
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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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
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ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
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PERMIT. ADB#_ —DATE INSPECTED—
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DESCRIPTION OF WORK TO BE INS TED
A e nal approval
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fl Id inspection was conducted to determine final compliance with approved p
. den . otes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
insp
u Copy of CONDITIONS given to owner/contractor by ector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
ci Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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USE PERMIT
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY zip TELEPHONE
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NAME
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CITY ZIP TELEPHONE
NAME CBL #
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STATE LICENSE NUMBER E RA ON DATE
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PROPE ACCO NMPARr.EL N Q 7
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NEW RESIDENTIAL --'g PLUMBIN
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COMPLIANC�;)
ADDITION IVCOMMERCIAL CHANGE OF USE
.EMODEL MULTIFAMILY SIGN
REPAIR GRADING FENCE
CYDS ( _ X_FT)
0 DEMOLISH TANK OTHER
GARAGE RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(ME OF USE, BUSINESS OR ACT MLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORlis UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
PLAN CHECK NO:
ZONE NUMBER dqiV0
JOB — I go'l-
ADDRESS 0?
PLAT NAMEISUBDIVISION NO.
OT NO.
LID NO.
L
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCF ApPrOV90
Rw Permn RaWked
Street Use Pwmft RKd
EXISTING — PROPOSED
inspection Requited
Sidewalk Required
REQUIRED DEDICATION— FT
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METER Sl ZE
LINE SIZE
NO* OF FIXTURES
PRV REQUIRED
YES [3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
REVIEWED BY 1 1, _r�,j ( ) DATE
FIRE REVIEWED BY
DATE I
VARIANCEORCU
BOND
ta;N W0AoB;#4
ZINSPECTION
REO'D
13NO
POSTED
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s
S
SEPA REVIEW
SIGN AREA'
HEIGHT
UUMMME EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT / SIDE REAR
FRONT URSIDE REAR
PARKING
U
LANNING REVIEWED lay DATE
RE PROVIDED
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CHECKED BY 1�=C NSTRUqTj0N
SPECIAL INSPECTION AREA
REQUIRED 0 YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL
VAL AMON
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Description FEE
Plan Check
GLAZING % I LOT SLOPE % 4:�4
r t uilding Permit
VESTED DATE 11 Plumbina
OCCUPANT
GROUP
OCCUPANT
LOAD
Description FEE,
State Surcharge
City Surcharge
F Ar f
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DOME ON PRIVATE PROPERTV ONVIlit AM CONSTRUCTION ON THE PUBLIC
Grading
X DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQ I UIRE
SEPARATE PERMISSION.
Engr. Review
PEnunrAppuramoi: isoulAys
IL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE 13ACK OF PINK PERM11"T FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, IT$ OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
a -.4 -
±DuEN
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
LWAgpell-d6p.
Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROY .......
NJ
#
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Recording Fee
Receipt
'ON
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
---
APPLICATION
APPROVAL
0,
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
U C
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 6
TION; AND IN DOING TH&ASmALOORIZED THEREB`Y, NO PERSON WILL BE EMPLOYED
I To
IN VIOLATION OF TH20EAS98,P00 F THE STATE OF WASHINGTON RELATING TO
'11E
FOR INSPECTION
Building official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
INJURAN AND RCW 18.27.
WORKMEN'S COMP��019_
FICIA 10 DATE
-
81,ZTULRE (00WI'JER J)R A ENT)
DATE SIGNED
(425)
.)- a
�r
771-0220
D BY DATE
77TENTION
Off 1333
CUP UILC
IT IS UNLAWFUL TO USE Oil OCCUP UILDING OR STRUCTURE UNTIL
WAPPROVAL
G/
A FINAL INSPECTION HAS BEEN MADE OR A CERTIFI-
ORIGINAI -FIIF: YELLC(N - INSACTOR
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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