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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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NAME
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NUMBERZ019
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ADDRESS 1A )0, IN Id -
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Perntit Required
Street Use Permit Req'd
EXISTING - PROPOSED-
Inspection Required
Sid &walk Required
REQUIRED DEDICATION- FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES13 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL N 10M ENGINEERING REVIEWED BY DATE
r.!Y�`�TTAT'IT -m uw 605.2
FIRE REVIEWED au
ZIP TELEPHONE By A WAT ER SERVICE SrIUTOME
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VARIANCE OR CU wff-frlsq- BOND
EXPIRATION DATE REQ'D POSTED
(3 DYES 13NO
Advaj. SEPA REVIEW SIGN AREA HEIGHT
ACEL NO. I I COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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PROPOSED SETBACKS (Fr.)
FRONT L/RSIDE REAR
ADDITION
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PORT
GRADING
1:1 CYDS
TANK
RETAININGWALL
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( _ x _FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
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REMARKS
(TYPE OF USE. BUSINESS
OR ACTAMY) EXPLAIN:
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NUMBER
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NUMBER OF
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UNITS
CRITICAL
AREAS
NUMBER AM--
SPECIAL INSPECTION
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JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 10811FINAL INSPECTION REOD
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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 NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
3 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
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Engr. Review
PERMIT APPLICATION: 160 DAYS
PERMIT LIMM 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 ME CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 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 C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Recording Fee
Receipt #
2 30 U
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 until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATIO��RANCE AND RCW 18.27.
OFFIC S —SIGNATWRE
SIG URE (OWNER OR +6M
DATE SIGNED
(425)
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771-0220
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RELEASED BY d%TE
ATTENTION
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 Sign,
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DATE RECEIVED 1z
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OV7 NAMEMME OF 07SINESS
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MWL'ING ADDRESS
9-7 -S
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAME CBL #
d6ir'd
ADDRESS
CITY ZIP TELEPHONE
'7klc,-7 1 1'44-(4,33-17 ive
STATE LICENSE NUMBER
PROPERTY TAX, ACCO PARCEL NO. I 0I .�
to U162- Q 7/ a2l 60
NEW lErRESIDENTIAL WrLUMBING / MECH
[] COMMERCIAL COMPLIANCEOR
ADDITION 1:1 CHANGE OF USE
REMODEL MULTIFAMILY 1:1 SIGN
19 REPAIR rl GRADING CYDS [3 FENCE X
( FT)
1:1 DEMOLISH 0 TANK OTHER
IGARAGE o RETAJNINGWALL 0 F RE SPRINKLER
3 CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
NUMBER NUMBER OF ICAL
DWELLING AREAS
Mdq I /yA
NUMBER
DESCRIBE WORK TO.BE DONE
I& f
' ,0 ?4 r i 1 1
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITFAPPUCATIOW. 180 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 INDEMNIF% 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 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CaYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 13 CORRE" 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
WORKMENS COMPENSATIS��RANCE AND RCYY 18.27.
SIG�TURE (OWNER OR kG�Nl) j DATE SIGNED
'�?� I _0y- o-3
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PERMIT EXPIRES
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USE PERMIT Zoo
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NUMBER
JOB SUITE/APT#
ADDRESS 1A )(110 /Z �- 5 7p-
PLAT NAME/SUDDIVIGION NO. LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
AW Penrht RaWksd
Street Use Permh Wd
EXISTING — PROPOSED
Inspecdon Roquked
Sldews* RaWW*d
REQUIRED DEDICATION— FT
Undergmuml
WWgfeq ired
METER SIZE
LINE
OF FIXTURES
PRV REQUIRED
1
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
PURSLIAhrr 7n UPC 605.2
VARIANCE 0"
MAL
LINIfiAn'lab
IS
0
BOND
POSTED
SEPA REVIEW
COMPLETE . EXEMPT
SIGN AREA
I ALLOWED PROPOSED I
HEIGHT
At I OWED - PROPOSED
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAn
FRONT UR SIDE REAR
PARKING �LOT AREA �FLANNING REVIEWED BY DATE
REO'D CDC 19.30-020
ATM MAT Ura a=
REMARKS SHALL BE INSTALLED NEAR
THE WA7IVF9fl=_FF
CHECKED BY
ITYPE
CQNSIRUCTION
L
CO-041
t9a
OCCUPANT�C'7
GROUP
SPECIAL INSPECTION
JAREA
OCCUPANT
REQUIRED [3YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC
1108/FINAL
INSPECTION REO'D
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr� Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
7 Ll:;pl
Recording Fee
Receipt #
CALL
FOR INSPECTION
1A9
1425)
771�0226
APPLICATION APPROVAL
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.
OFFI LS AIGNATJORIF DATE
REL 0 BY 6ATE
EASE
ATTENTION LAI 13
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
a