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PERMIT EXPIRES
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USE PERMIT 0
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NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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OWNER NAMEINAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LF NO. LID NO.
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MAILING ADdRESS
LID FEE $
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TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerfrA Required
CITY ZIP TELEPHONE206 -.5rV.2. 6 iC OP 0
Street Use Permit Wd
EXISTING - PROPOSED inspection riequired
Sidewsk Required
2-S- -30--b
REQUIRED DEDICATION- FT 1 Undeveround
wmgreq 13
NAME
METER SIZE__ I LINE SIZE I NO. OF FIXTURES PRV REQUIRED
YESD NO 13
ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
NAME _jCBL#
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ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE REVIEWED BY DATE
CITY TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR Cu SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
13YES 13NO $
SEPA REVIEW SIGN AREA; HEIGHT
PROPERTY
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
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ALLOWED PROPOSED FRONT SIDE
ADDITION dCOMIMERCIAL COMPUANC OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REOD PROVIDED
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REMARKS
0 OTHER
DEMOLISH TANK
oGARAGE o RETAININGWALL o FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
UWE OF USE, BUSINESS OR ACTIVIM EXPLAIN:
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CHECKED BY P F CONS LICTION OCCUPANT
GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION OCCUPANT
STORIES UNITS nr NUMBER
JAREAV
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION hr-010
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VALUAnON
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Descrlpftn FEE Deacription FEE
Plan Check State Surcharge
HEAT SOURCE GLAZNG % LOT SLOPE %
Building PerMit. City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPEHN ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
:3 DOMAIN (CURBS, SIDEWALKS, DRRfEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
PERMIT APPLICATION: ISODAYS
n PERMIT ILIMM 1 YEAR - PROVIDED WORK 18 STARTED WITHIN 150 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 MATURE, 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 CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee Receipt #
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.
8 1
CALL lie flon is no' a permit Until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
th DAu y: and Fees are paid, and
I of hi. " I�n
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION i0grea ,aal
t Is acknovvIoqi;qd space trovided.
WORKMENS COMPENSA _t".URANCE AND RCW 18.27.
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SIGNATURE (OWNER 0 AGENT) DATE SIGNED
Fit 0 # "ATURE DAT
(425) 182
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C9 _5
771-0220 — ZF
R LIM61—Y DA
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 YELLON- 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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NUMBER
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CONSTRUCTION PERMIT APPLICATION
ADDRESS
OWNER NAMERME OF BUSINESS
—0 C_ j0a-,fffl%V') 2z c. PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING AID RESS LID FEE S
TESCP Approved
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�5 RSUM
Use Perm.4 aoq'd
CITY ZIP TELEPHONE206- 574/X 6 e EXISTING PROPOSED "paction PAqL**d
Sidewalk Rewired
Underwound
0z REQUIRED DEDICATION— FT WMilrequired
NAME METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
I
YES E3 NO 13
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
a
CBL#
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NAME ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE REVIEWED BY DATE
CITY zip TELEPHONE
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VARIANCE OR CU SHORELINE OR ADBM INSPECTION BOND
6 TATE LICENSE NUMBER EXPWATION�DATE CKED B7 REO'D POSTED
13YEs 13NO s
SEPA REVIEW SIGN AREA HEIGHT
PRDPEF T COMPLETE , E PROPOSED
DTD U Go I f V'N XEMPT ALLOWED I PROPOSED ALLOWED, M�
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RESIDENTIAL LOT COVERAGE REQUIRED SETBACK$ (Fr.) PROPOSED SETBACKS (Fr.) -4
NEW gepLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR, 0
COMPUANCE OR
13 ADDITION dCOMMERCIAL CHANGE OF USE
LOT AREA
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DATE
REMODEL muLnFAmwy 0 SIGN REOD PROVIDED
FENCE z
GRADING
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[3 OTHER
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0
GARAGE RETAININGWALL 0 FIRE SPRINKLER Sn
CARPORT 13 ROCKERY FIRE ALARM
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CHECKED BY OCCUPANT M
2-Z C*-- LICTION GROUP 12- M
NUMBER IUMSER OF ctr�
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OF AREAS SPECIAL INSPECTION JAREA' OCCUPANT
NUMBER LOAD
STORIES UNITS REQUIRED [:] YES C
DESCRIBEWORK TO HE DONE ic
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REMARKS ITI
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE9D
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_66 16
4.- VALUATIO W%Ifftl
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DescrIptlon FEE Description FEE z'
0
Plan Check State Surcharge
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HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AU71114`0011=8 ONUV TM WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLM ANY CONMUCnON ON THE PUBLIC
a UIRE
n DOMAIN (CURBS, SIDEWALKS, DOWMAYS. MARQUEES, FTC.) WILL REG Grading
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: 180 DAYS
PERMrF ILIMM I YEAR -PROVIDED WORK IS STARTED VMIN 1180DAYS 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 Landscapeffisp. Total Amt. Duo
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
I HERE 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
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THE OWNER. I AGREE TO COMPLf WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
8 IcatIon Is not a peffrift Until signed by tho
�rlPlt
TION. AND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
go or his/her DAuty: and Foos we paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Vl�
Is aanowlecliefd In space provided.
WORKMEN$ COMPEN=RANCE AND RCW 16.27,
F1 I
elli DAr
SIGNATURE (OWNER 4 AGENT)
DATE SIGNED
1A030)'.
I
177TURE 4Ct� Li
'03
%1W1`6
771-.0220
10
hifIE'DIBY
JR
hL 1 0 A
"' ' '
L
DATE
ATTENTION
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