20030064.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Description
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Description
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Building Permit
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PLAN CHECK NO: VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
X DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 100 DAYS
CL PERMIT IUMM I 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. 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECM 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 unfit signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Otlicial or his/her Deputy; and Fees are paid, and
IN VIOLATION OF THE E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPE
,NSATI NCE AND RCW 18.27.
OFFICIALS SIGNJITURE
-
SIGNATUR OW DATE SIGNED
'41-05)
FA�
;�T
771-0220
RELEASED BY U CATE
�NTION
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 - 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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DATE RECEIVED
112. � F/� 7 LERMIT EXPIRES
USE PERMIT
ZONE Z ut)
CITY OF EDMONDS NUMBER 0 oo&
JOB
F CONSTRUCTION PERMIT APPLICATIONTADDRESS SUITE/APT#
OWNER NAME/NAME OF BUSINESS
P PL
LAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
Q a__i )
CITY ZIP
L, W
NAME
ADDRESS
CITY
NAME
ADDRESS,'�'
STATE LICENSE NUMBER
ZIP
ZIP
TELEPHONE
14 -)C; —
ROPERTY TAX ACCOUNT PARCEL NO.
NEW
Gi_)RESIDENTIAL
ADDITION
COMMERCIAL
0 REMODEL
0 MULTIFAMILY
REPAIR
GRADING CYDS
0 DEMOLISH
TANK
[3 GARAGE
CARPORT
RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
11�jp!;i
I Iq I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
CBL # 1141 1
ENGINEERIJ
FIRE REVI'E
VARIANCE
rM_pLUMBING I MECH
7—COMPLIANCE OR
CHANCE OF USE
SIGN
oFENCE
( — X_FT)
OTHER
F RE SPRINKLER
FIRE ALARM
SEPA
COMPLETE
E4f!_.;;, .1
LOT CC
ALLOWED
REQ`D
Mr___ I
St of whetilt:( il,e
on
LID FEE $
TESCP APPleved
AW Pan* Requked
So" Usa Parmh RaoVd
REQUIRED a
NO 13 Z
�GE
miuAwtvill LU
CC
tanks
,1:;110
of BONI
POS o
LLOWED PROPOSED
IOPOSEO SETBACKS (FT)
RONT LIR SIDE REAR
Ila
BY DATE
CHECKED BY ITYP=ON I C,05S-Z OCCUPANT '
rK— GR
CRITICAL
AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMBER A4 I LOAD
REQUIRED 0 YES
92 __IREMARKS
I PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
4�x n6", - t- -A-, - .- :.It - ^. 11 - _- - -
CA- h4 (L4 " pi
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jto_��w j
s no
Description
FEE Description FEE
1A )MfA
Plan Check
State Surcharge
FICE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
WW======
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: IBODAYS
PERMIT LIMIr I 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 NTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMIIONDS. 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
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
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
GWEN 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 until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
IN VIOLATION OF THE B E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Bwldlng Official or his/her Deputy" and Fees are paid. and
receipt is acknovAodged In spaco ixovidod.
WORKMEN'S COMP5NSATI CE AND RCW 18.27.
OFFICLAL S1117URE DAT7
SIGNATUR 0 DATq SIGNE2.
-7
IA135)
j �;I
7�
qRO
771-0220
RELEASE--D- -8-Y 15ATE
A*17TENTION
Off 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- 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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0
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0
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