20030148.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS I
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CITY ZIP TELEPHONE
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NAME
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PERMIT EXPIRES
USE
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PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS 2161t, -
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
RW Parodt Required
Street Use Permit Roq'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required 13
REQUIRED DEDICATION— FT
UndarWound
"..gf.q r 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
YES 13 NO 13 z
15
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REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY I ZIP
TELEPHONE
NAME
BLN
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ENGINEERING REVIEWED BY
DATE
ADDRESS
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FIRE REVIEWED BY
DATE
ZIE TELEPHONE
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STATE LICENSE NUMBER 4 11%T E CH
VARIANCE OR CU SHORELINEORADBN L INSPE BOND
......... "Of Re%40YES "ON
RE(:�D POSTED
_,WO
SEPA REVIEW SIGN AWA_ '% HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPPI ALLOWED PROPOSED
ALLOWED PRqfOSED
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J524 ; '000 — oy-66
-
EXP
NEW RESIDENTIAL
LU BING ECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Rd"?
ALLOWED PROPOSEDIFFIONT SIDE
REAR FRONT L/RSIDE REAR
ADDITION COMMERCIAL
COMPLIANCE OR
/VO /h7 00%
REMODEL 0 MULTIFAMILY
CHANGE OF USE
SIGN
PARKING T AREA PLANNING REVIEWED JJY DATE, 9
REOD
aOVIDED
IVO A*fti
REPAIR GRADING
CYDS
FENCE X
FT)
REMARKS
DEMOLISH TANK
OTHER
oGARAGE RETAININGWALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSIN
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CHECKEDBY JTYPE.OFC�NSTRUCTICIN
-71
OCCUPA
_6ROUP
NUMBER NUMBER OF
CRITICAL
OF DWELLING
M I 14d
AREAS
SPECIAL INSPECTION JAFFEA
OCCUPANT
STORIES UNITS
NUMBER
REQUIRED [:] YES
DQe
LOAD
/D
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC
108/1FINAL INSPECTION REO'D
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VALUATION
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Description —FEE
Description FEE
Plan Check
State Surcharge
HEAT SOURCE
%
LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
City Surcharge
PLAN CHECK NO,
A
4.1�z
Mechanical
THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRIJWION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: ISO DAYS
PERMIT UMrr 1 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
41—
I
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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
45
Receipt #
W-1
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
10)
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapoinsp.
Total Amt. Due
TO MODIFY, WAIVE OR REDUCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
211*-')1_))
1 HERE13Y 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 W" CITY AND STATE LAWS REGULATING CONSTRLIC-
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/hot Deputy: and Fees are paid, and
IN VIOLATION OF TH I OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S % COMPENS No RCW 18.27.
DATE
S'GZ E RO GE
DATE SIGNEP
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Of
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771-0220
-WEAS-E
DBY DATE
AITENTION
EXT 1333
IT IS UNLAWFUL TO USE��Y A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGI�� - Fl�E YELL`CW - INf(PECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINI�-OWNfR GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES '--GRI-'EN - ACCOUNTING
FINAL PROJECT APPROVAL FORM
a
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sigti,___
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