20030083.pdfa
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
16 11 t 56
CITY ZIP TELEPHONE
06--?X?
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NAME
ADDRESS
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
ZIP
ZIP I TELEPHONE
TAX ACCOUNT PARCEL NO.
CBL N
I�K2
I PERMIT E
XPIRES Z7,644CZ.�.4
USE PERMIT
ZONE
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NUMBER �'V'5
JOB
ADDRESSZJ
SUITf/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW PorrrJt Requir
Street Use PeffnhReWdT
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
UndeWound
Winne required
METER SIZE
LINE SIZE .7.
OF F IXTURES
PRV REQUIRED
YES C3 NO 0
REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
A - . - . -
11
BY DATE
FIRE REVIEWED BY DATE
- - VARIANCEORCU SHOPIELINEORADB11 INSPECTION BOND
EXPIRATION DATE I CHECKED BY REQ'D POSTED
I 13YEs 13NO 1$
SEPA FIEVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I
nEQUIOED SETBACKS I V PROPOSED SETBACKS IFTI
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
0 REMODEL
MUL11FAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
[3 RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVTrY_) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS ;V/.),
DESCRIBE WORK TO BE DONE
LO COYERAGE;
PLUMBING/MECH PROPOSED
ALLOWED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
0 SIGN REO'D PROVIDED
FENCE I I
( X F11 REMARKS
0
FIRE SPRINKLER
FIRE ALARM
CHECKED 13Y I 11PE
XPE F
CRITICAL
AREAS SPECIAl INSPECTION
C
NUMBER REQUIRED 0 YES
REMARKS
[PREOGRESS INSPEC
OCCUPANT
GROUP
OCCUPANT
LOAD
PER UBC 1081FINAIL INSPECTION REaD
2:ep
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- (_1/ 61_�_p VALUATION
CV
$
Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check State Surcharge
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: 160DAYS
I
PERMIT ILIMM 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
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.*
Recording Fee
Receipt #
1 HEREHY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPMATION
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 IPRK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE JOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees Oro Paid. and
receipt Is acknowledged in space provided.
WORKMEN'"O��QS N INSURANCE AND RCVV 18.27.
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OFFO�LS SIGNAYU�E DATE
81133��')I!IWNER A AGENT)
DATE SIGNED
1AID
14,25
i>
-022
771 0
DATE
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
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GREEN - ACCOUNTING
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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