20030101.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
ZIP TELgPliONE
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NAME
ADDRESS
CITY ZIP [TELEPHONE
NAME ICBL#
ADDRESS
ZIP
IPERMITEXPIRES
USE PERMIT Zoo 3 , 0/ e) j
ZONE NUMBER
JOB SUITE/APT#
ADDRESS e
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T N A M
PLAT NAME/SUBDIVISION NO.
P LA
LOT NO.
LID NO.
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P U13 L
7ESCP APF;0ved
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susel use Pamik goq'd
EXISTING PROPOSED-
InspecUon Re4idred
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EQUIRED DEDICATION— FT
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LICENSE NUMBER EXPIRATION DATE I CHgr" BY
PARCEL NO.
NEW
f,RCU
L ARESIDENTIAL
QJPLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
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SIGN
REPAIR
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CYDS
FENCE
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0 TANK
OTHER
GARAGE
CARPORT
[3 RETAINING WALL
ROCKERY
o F RE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
S
/V)9—
STORIES
UNITS
LAAREA
NUMBSER
DESCRIBE WORK TO BE DONE A Vf4V
ENGINE RE IEWED BY eeto D AT E
Type B or L vent conn rs T
0 4 A In ftel hilim-1;aR gapling
FIRE R, IMIffle"' _' .1.7 ATE
unheated spaces- UbAC 815-1-7 cc
VARIAN&VfM_ HORELINEORA913#11 INSPECTION I BOND
REO'D POSTED
1E3YEs 13NO Is
SEPA REVIEW SIGN AREA HE113HT
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED , PROPOSED
LOT 'KS ,
�IS FT PROPOSED SE CKS (Fr.)
NILLOWE PROPOSED fRONT SIDE- - : AR -FKUNI W E REAR
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PA G 0 IN 'PLY"A *N&
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v q alla"I' o n all h t Water tanks per
161 W%Wj CF. L.VLLfV 110.0%j
CHECKED BY ITYP CO T N OCCUPANTA a
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SPECIAL INSPECTION AREA OCCUPANT
REQUIRED n LOAD
REMARKS
1PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'0_]
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VALUATION
VLM Ulyl -
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
4&
Mechanical
Ago
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t__ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: 180DAYS
&L PERMIT UMM 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
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 MY CITY ORDINANCE
Landscapoinsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee
Receipt #
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAI
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Foos are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
91E AND RCW 18.27.
WORKMEN'S'POMPENSAT15"44,URAN
0 ��LIL S. S I G NIPM R E TE
SI U OWNER 0 E DATE SIGNED
(409.5)
I �ilmwk sb1o;
771-0220
RELEASED BY DATEF
ATTENTION OF
EXr 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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PDATE RECEIVED
PERMIT EXPIRES %� I 1U
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CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS 12_3 (30,3 )06FIK PVE: G.Ij
OWNER NAMEINAME OF BUSNES19
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS j
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP c.P'.1*1'=' ad
Street uge Peffnit Rated
C ZIP TELEPHONE
EXISTING ulred
Sidewalk =lred
May -1 H1122
13
RE UI____
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NAME
M Ey&te Ll�
AOSIZE & RIREQUIRED
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YES NO 13
ADDRESS
RE
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP 7� ONE
NAME BLN
Xkr,-71( _D _7
ENGINEERING REVIEWED BY
ADDRESS
L 31oul connectors
FIRE R on fuel -burping appil
ZIP
UMC 815.1.7
rL
�ELEPHONE
STAATIE LICENSE NUMBER EXPIRATION DATE CHE BY
VARIANC OR CU_ SHORELINEORADBO
REQ'D POSTED
InFIGPI elsqSQ2L) C
13YEs ONO $ HEIGHT . !
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA
U U MMETE EXEMPT ALLOWED PROPOSED ALLOWED PR 00 OSED
EXP , ,
NEW RESIDENTIAL LUMBING / MECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR
13 ADDITION 0 COMMERCIAL CHANGE OF USE
CA -gamin
- " "
EMODEL 0 MULTIFAMILY SIGN
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DEMOLISH 11 TANK OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 0 ROCKERY FIRE ALARM
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
'Pr
CHECKED BY OCCUPANTA,3
TYPM=
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I .11EY, GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
Nq
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
MB R
STORIES UNITS NUMBE
REQUIRED 11 YES
DESCRIBE WORK TO Bt DONE
I
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
I A % 2
$ C)
Lt v uyin r mryj
10 30
ROA ICAC-0 `<t All� j A Description
PEE
DescrlpUon
FEE
Plan Check
j
S late Surcharge
I
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit
City Surcharge
Ci
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1:
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
a
DOMAIN (CURBS, SIDEWALKS, DRIVEVAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAVS
ERUIT IUMrP 1 YEAR - PROVIDED WORK is STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. Deposit
* APPUCANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review
IN INTEREgi 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
Total Amt. Due
"Vn
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C17Y ORDINANCE
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY onoINANCE PROVISION.
Recording Fee Receipt # ;:;i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION API 'RovAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPUDYED CALL 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.
WORKMENSCOMPENSAT1q"*lkJRAN9E AND RCW 18.27.
OFFI SIGN TURE ATE
25 9
DATEISIGN D
n'.a r D' /fi
REI EASED WF
771-0220 �AT
PONTION EXT 1333
w 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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