20030149.pdfI
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
0 ER NAME/NAME OF BUSINESSV
MAILING ADDRESS
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diTy ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
q6RIT&C SEVILE CORE,
ADDRESS
31 IX Ev&re--;fl AAafl
CITY zip
STATE LICENSE NUMBER ' LAPIKA11
40o-r,,�ASSR-T q_1
PROPERTY TAX ACCOUNT PARCEL
13 NEW
RESIDENTIAL
ADDITION
COMMERCIAL
13 REMODEL
MULnFAMI1.Y
0 REPAIR
GRADING CYDS
DEMOLISH
[:3 TANK
GARAGE
CARPORT
o RETAJNING WALL
ROCKERY
UWE OF USE, BUSINESS
ORACTIVITY) EXPLAIN:
NUMBER
'WUMBER OF
OF
OWELUNG
STORIES
UNITS
DESCRIBE WORK TO BE DONE
CBL #
USE
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JOB
ADDRESS
I PERMIT EXPIRES L[ a
PERMIT /) fA 03 ,()1 q I
NUMBER OLU
SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appro"d
RW Perftt Required
Street Use Permit Req'd
EXISTING — PROPOSED
InspecUon Required 13
Sidewalk Required 13
REQUIRED DEDICATION— FT
Underground
ulred 13
METSR SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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I YES 13 NO 13 z
REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION I BOND
CHECKED BY REO'D POSTED
113YEs 13NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED I PR
vtoo "D I I
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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FT)
o OTHER
[3 F RE SPRINKLER
FIREALARM
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
PARKING LOT AREA PLANNING REVIEWED 13Y DATE
REQ`D I PROVIDEO.1 .V _.ft I - . *-_We7 0.2A 1�r—
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REMARKS
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PROGRESS INSPECTIONS PER UBC
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AuTHIORUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CUR13S, SIDEWALXS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPUCATION: 180 DAYS
PERMIT UUM 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 INTEREST. 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. ISSUANCE 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 HERESY 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 TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
WaW,UME (OWNER OW,99'qR6_) DATE S)GftED
VALUAnON
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
R INSPECTION
(425)
771-0220
FEE
AU-9NTION I Off 1 33 r
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
OCCUPANT
GROUP .0
OCCUPANT
LOAD
INSPECTION REaD
Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION API IROVAL
0'aWlIcation is not a permit unto signed by the
?OffcIaI or his/her Deputy: and Fees are paid, and
re4ipt Is acknowledged In space provided.
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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NUMBER
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PUBLIC RIGHT OF WA PER OFFICIAL STREET MAP
TESCIP Approved
AW Penr9t Required
Street Us* Famil RSqd
diTy ZIP TELEPHONE
EXISTING
PROPOSED-
Inspectlo Required
Required
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REQUIRED DEDICATION— FT
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NAME
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LINE SIZE
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PRV11EQUIRED
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ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
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LOAD
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REQUIRM
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DESCRIBE WORK TO BE bONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1100MININIL INSPECTION REQ'D
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VALUATION
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Description
FEE
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FEE
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State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
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City Surcharge
0
Plumbing
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PLAN CHEC 0:
VESTED DATE
22 2e
Mechanical
THis OEfiurr AuTHoRcms 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
h
SEPARATE PERMISSION.
Engr. Review
IPERMIT APPLICATION: ISODAYS
IL
PERMIT.LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERHrT FOR MORE INFORMATION
H OR HER"iPOUSE. HEIRS. ASSIGNS AND SUCCESORS
-APF ON BEHALF Is
Fire F,1FV!9w
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
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I
eee�
NOR LIMIT IN ANY WAY THE
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 CRY AND STATE LAWS REGULATING*CONSTRUC. CALL This i 'IcaUon 13 not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED law Q -let or his/her Deputy: and Fees are paid, and
t Is acknowle"od In space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION I
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
TUR
014LFWALVS71� �ATE
DATE S GNED 11A2
RE (OWNER 0 M)
E
yv (-/1 771-0220 6 ar I DATE
I FIR
An ION EXT 1333
IT IS UNLAWFUL TO USE 00 OCCUPY A BUILDING OR STRUCTURE UNTIL
ORIGINAL FILE YELLOW INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
GREEN ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES