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DATE RECEIYED ,
4v�
i I PERMIT EXPIRES
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CITY OF EDMONDS
USE PERMIT
ZONE NUMBERft!�_
PERMIT APPLICATION
JOB SUITE/APT#
_CONSTRUCTION
ADDRESS
OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESSF
LID FEE $
TESCP App"mod
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permit Requit
street Us@ Permit 1.4�d
CITY ZIP ELEPHONE
EXISTING — PROPOSED Inspection Required 13
Sidaw&lk Required 13
(3-Z
eclnZ�_D __Zo
REQUIRED DEDICATION— FT UndevgrmM
Wiringrequifed [3
NAME
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
YES13 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
NAME CBL 11
ENGINEERING REVIEWED BY DATE
ADDRESS
CITY TELEPHONE
Zip
FIRE REVIEWED BY DATE
Lu
14.F=l Aq
VARIANCE OR CU HOR§LINE OR ADB#. INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE I CfffCKED BY
RE02/ OSTED
nV
_113YEs
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA
COMPLhIE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
NEW RESIDENTIAL PLUMBING MFCH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR
0410
ADDITION MMERCIAL CHANGE OF USE
PARKING LOT AREA REVIEWED Say AT
CL.
0 REMODEL MULTIFAMILY SIGN
REO' IDED
1��NING
I flucv_
0 GRADING FENCE
ZMEPAIR CYDS ( _ X_FT)
REMARKS
[] DEMOLISH 13 TANK OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
OWE OF USE, BUSINESS P"CTIVIIM EXPLAIN:
CHECKED BY TYP!=UCTION C7 OCCUPANAL—
A GROUP&
I g
NUMBER NUMBER OF CRITIC
OF DWELLINi� AREAS
—
kNT
SPECIAL. INSPECTION JAREA LOAD
—STORIES UNITS NUMBER 1111A-
REQUIRED [3YES
DESCRIBE WORK TO BE DQNE I
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
vALuArON
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I
Building Permit City Surcharge
PLAN CHECK NO: VESTED DxrE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPAPATE PERMISSION.
Engr. Review
PERMITAPPLICATION: ISODAYS
PERMITILIMfr I YEAR -PROVIDED WORK IS STARTED WITHIN 1180DAYS
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, WASHINGTON, 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 BE
Landscape Insp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Receipt
Recording Fee
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRE" AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
This applicaUon is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL his/her Deputy: and Foos are and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLJDYED
Building Official or paid,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICI NAT
SIGNATURE (OWNER OKAG�NT) DATE SIGNED
(425)
771-0220 aTE
ATTENTWN
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL V IL--o
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPEITOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
d
a
AM 15
Ilk, IRES
'A lilt
7; 1PERMIT EXP 7
USE PERMI
CITY OF EDMONDS ZONE NUMBER?ft!1
Joe SUIMAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMENAME 0 INESS
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
MAILING ADDRESSP
lt�e,
LID FEE S
TESCP Approved
--7e:=hC=N —
PUBLIC RIGI-fr OF WAY PER OFFICIAL STREET MAP
RW Ponrift'Reaulted
EXISTING — PROPOSED
Street Use Parinit RKd 13
hupection Required 13
fildewa& Required 13
CITY
ZIP
TELEPHONE
7 d_-ao
RhQUIRED DEDICATION— FT
ur'd
wim= 13
METER SIZE
LINE SIZE
0, OF FIXTURES
PAV REQUIRED
[
YES [3 NO 13 z
ADDRESS
REMARKS I
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I
."§ I CITY
ZIP ITELEPHONE
NAME CBLN
-&rm"+—ru I ENGINEERING REVIEWED BY DATE
!Fak M61
ADDRESS
—1:1&. (CX-e, FIRE REVIEWED BY DATE ku
CITY ZIP TELEPHONE OrE,
:S�� 9614.w,- -1 "0 - ' VARIANCE OR CU SHORUUNEORADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION PATE C CKED 0 1p-r REQ�K OSTED
_'" A&V I �w I 1 /0) A- L�� �_ N , ik I 113YEs _ 1$
oo NEW
[j RESIDENTIAL
ADDITION
air,_eOMMERCrAL
REMODEL
0 MUL11FAMILY
ZAEPAIR
GRADING CYDS
.0 DEMOLISH
TANK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS .0fl-ACTIVITY) EXPLAIN:
NUMBER.
OF
N UMBER.Of
DWELLING
I
STORIES
UNITS
DESCRIBE WORK TO BE DONE
rvAzL — e!2 ", IoLftc=a j. ip A~4�i
SEPA REVIEW
SIGN ARE
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
P, -
1_
EXP
T_ ..—
LOT COVERAGE
REQUIRED SETBACKS (Fr)
PROPOSED SETBACKS (Fr.)
13 PLUMBING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
COMPLIANCE OR
------- �
,13 CHANGE OF USE
PARKING
LOT AREA
REVIEWED BY
0 SIGN
REQ
IDED
PIP6ANNING
o FENCE
X FT)
REMARKS
OTHER
FIRE SPRINKLER
FIRE ALARM
CHECKED BY JTYP�ff
CRITICAL /,VUCTION
AREAS SPECIAL INSPECTION JAREA
NUMBER
REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONS PER UBC
GROUP
OCCR
LOAD
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK HOTED. THIS PERMrT COVERS WORK TO
t: BE DOME ON PRIVATE PROPEM ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURSS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SFARgPIEROSSION.
E Review
I
PEFIMITAPI . dp'AoPL- 49DAYA
DAYS
.!Igr. —
—
PERMIT LIMM I YM - PROVIDED WORK 18 BTAMb WITHIN 180
ction
gr. Inspection
BEE BACK OF PINK PERMIT FOR MORE INFORMATION
I
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, IIEIRS. ASSIGNS AND SUCCESORS
V
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSLLANCE OF THIS PERIAM ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt
I f�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN'18 CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL
This applilcallon Is not a perntit until signed by the
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
FOR INSPECTION
Building Ofklal or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space Provided.
WORKMERS COMPENSATION AND RCW 18.27,
OFFICIAL N7AT ATE
__��SURANCE
SIGNATURE (OWNER AGEM��S
DATE SIGNED
t0f)
4:5
771-0220'
— -
ATTENTICIN
EXT 1333
1
IT IS UNLAWFUL'TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW-i
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
.. ..... ...