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DATE RECEIVED
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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
ADDRESS
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CITY ZIP ITELEPHONE
NAME K01"o CBL N
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DD 2-3(425 W4 P-b
CITY ZIP
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
TAX
0 NEW 0 RESIDENTIAL 0 PLUMBING/MECH
0 ADDITION OMMERCIAL COMPLIANCE OR
XC 0 CHANGE OF USE
0 REMODEL 0 MULTIFAMILY 0 SIGN
[—] GRADING
FENCE
REPAIR
CYDS
X FT)
DEMOLISH
X�TANK
OTHER
[GARAGE
3 CARPORT
RET:ININGWALL
13 ROCKERY
FIRE SPRINKLER
FIRE ALARM
OWE OF USE, BUSINEIS OR ACTIVITY)i E)�PLAIN:
M NUMBER /j// I CRITICAL
OF DWELLING AREAS
141 NUMBER OF
STORIES UNITS NUMBER
DESCRIBE WORIeTO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPILICATION: ISODAYS
PERMIT ILIMM 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 tNTEREST, 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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. 18SUANCE OF THIS PERMIT SHALL NOT BE
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."
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TA) COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING $E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIO;*IO�N JOFT SALABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORK 'S COM SATION INSURANCE AND RCW 10.27.
�RJW'(O' R JR AGENT) DATE SIGNED
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PERMITEXPIRES
USE PERMIT
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NUMBER
JOB SUITEIAPT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPI=.
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Strom Use Parmit RKd
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Undergrowd
wiring required
METER SIZE
LINE SIZ��,
I
OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL[DRAINAGE
, REMOVAL, OR
FIRE REVIEWED BY DATE lu
VARIANCE OR CLI SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
113YEs 13NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED , PROPOSED I ALLOWED , PROPOSED1
LOT COVERAGE REQUIRED BETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D PROVIDED
REMARKS
CHECKED BY ITYPE OF CONSTRP.CTION E OCCUPANT
�1�_ 1 C47 7 GROUP
SPEC1ALINsPEcnON ]AREA OCCUPANT
REQUIRED [] YES LOAD
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PER UBC 11081FINAL INSPECTION REQ'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
Recording Fee
Receipt #
CALL
FOR INSPECTION
1A10
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771-0220
EXT 1333
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 acknowledged in space provided.
OPFS ASIGW�T"qAE DATE
RELEASELD By DA_X_
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
SEE
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
cl Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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-DATE RECEIVED
44�L� :?> 1 1 PERMIT EXPIRES
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CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
—NUMBER
J013 SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
�A
L// 761
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE S
YESCIR Appm"d
PUBLIC RIGHT OF WAY PER OFFICIAL
j-j�
STREET MAP RW Permit flaquired
Street Use PeffM Reqi�d
CITY ZIP TELEPHONE
4S4
EXISTING — PROPOSED kiapection Required
Sidewalk Required
REQUIRED DEDICATION— Undergrourid
a3
41� _T_
FT 1 vvmg req 13
___Ivvmgreq
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO C3
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ADDRESS
REMARKS
2,3 (421
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
PRESENI EOR
NAME 0
TANK FILL, REMOVAL, OR CAP
ENGINEERING REVIEWED BY DATE
ADDRESS
Cly ZIP ELEPHONE
FIRE REVIEWED BY DATE
VARIANCE OR CLI SHORELINE OR ADB11 I INSPECTION 1$ BOND
STATE LICENSE NUMBER EXPIRATION DATE CHEC ED BY REO'D POSTED
I
E3YEs ONO
e&14L__;a
PROPERTY TAX AC90 NO.
URCEL I
Al
SEPA REVIEW SIGN AREA I HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
090 6-7, X&V 7
e 06
0
, ,
EXP
NEW RESIDENTIAL PLUMBING / MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR
ADDITION MMERCIAL
XCO
I
CHANGE OF USE
REMODEL muLTIFAmiLy SIGN
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REGOD I PROVIDED
13 REPAIR 0 GRADING CYDS FENCE X FI)
REMARKS
OTHER
DEMOLISH >CTANK
_
ciGARAGE o RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINE S OR ACTIV" EXPLAIN:
CHECKED BY ICTION CO E OCCUPANT
We
10A
_rCRITICAL
ITYPE
-6.— GROUP
NUMBE N.UMBER OF
OF ELL N. AREAS
SPECIAL INSPECTION AREA OCCUPANT
STORIES NUMBE
g
LOAD
REQUIRED r] YES
On
DESCRIBE WORKTO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
2
A% A%
VALUATION
$ V %F I I a R = W&' 92 U-4
Description
,i.FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOUR E GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERUff JWTHORIZES ONLY THE WORK OWED. THIS PERMrr COVERS WORK TO
t: BE DONE ON PRIVATE PROPER" ONLX ANY CONS1rRUCnON ON THE PUBLIC
Grading
2 VAYS, MARQUEES. IETC.) WILL REQUIRE
3 DOMAIN (CURBS, SIDEWALKS, DRIVE
t: SEPARATE PERMISGION.
Engr. Review
PEnMrTAPPUCATION: 1180DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 13 STARTE101 WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMrr FOR MORE INFORMATION
I
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESCIRS
Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOPIEES, 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
Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
wee
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TNs application Is not a permit until signed by the
CALL
TION; AND IN DO' WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Do MG
Building Official or his/her Deputy: and Foos are paid, and
VAGREE
IN VIO ON OF T ABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowtedged In space provided.
Wo 8 C INSURANCE AND RCW 18.27.
SATi
. OF L 6 SIGN E DATE
IT
8 R (*OR))R AGENTI DATE SIGNED
14. 22 5)
L
All
'A
771-0220
RELEASED BY
AikYION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPHOVAL OR A CERTiFl- 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