20030182.pdf11
DATE RECEIVED
PERIMVIT'EXPIRES
USE PERMIT
CITY OF EDMONDS
ZONE NUMBER",�5
CONSTRUCTION PERMIT APPLICATION
JOB !*JITE/APT#
ADDRESS
OW=N OF BUSINES.Sd
C!,
PLAT NAME/SUBDIVISION NO. LOT Nt LID NO.
MAILING ADDRESS
LID FEE S
Aw
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Perm" Roqd
CITY ZIP fELEPHONE
EXISTING — PROPOSED IrApectIm Required
SidewstIt Required
REQUIRED DEDICATION— FT UndwWound
Wiring required 13
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
I
Le
ADDRESS
REMARKS
z
R CTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
NAME CBL #
df&ma�
ENGINEERING REVIEWED BY 00 DW
IX
ADDRESS
7.
-ITELEPHO14E FIRE REVIEWED BY DATE
CITY ZIP
0
0
u
I'V-1
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIFIA�DN DATE CHI; KED by REO'D POSTED
1 1 is
1 13YEs ONO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL 110-
UUMMrft: EXEMPT ALLOWED PROPOSED POSED
afoEXP
, ,
NEW 0 RESIDENTIAL PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.). PROPOSED SETBACKS (Fr.)
FRONT LIPI
ONT SIDE REA SIDE REAR
ALLOWED PROPOSED FR R
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
PROVIDED
REPAIR GRADING FENCE
CYDS X FT)
REMARKS
OTHER
EMOLISH TANK
/U—!GARAGE RETAININGWALL FIRE SPRINKLER
13 0
CARPORT ROCKERY FIREALARM
UWE OF USE, BUSINESS OR ACTIVTM EXPLAIN:
CHECKED BY ITYPE OF qONSTRUCTION cong,__ OCCUPANT
GROUP
�OCCUPANTI
NUMBER HUMBER OF CRITICAL
OF DWELLING AREAS
SPECIALINSPE O� AREA
STORIES UNITS NUMBER
REQUIRED [j LOAD
YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
6619,W44- &"?A�
le Am& racgievts m
A/be- Xe owd
VALUATION
$
Description
FEE
DescriptIon
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit f2 City Surcharge
PLAN CHECK NO VESTED DATE
Plumbing
Mechanical
THIS PEPjArr AUTHORMANLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, FTC.) VALL REQUIRE
3
SEPARATE PERMISSION.
1:
Engr. Review
PERMIT APPLICATION: 180DAYS
n PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN IGO 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 INDEMNIR 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
NOT
FROM THE ISSUANCE OF THIS PERMrT. ISSUANCE OF THIS PERMIT SHALL BE
9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp. Total Amt. Due
2 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee Receipt N
I HERESY 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-
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 Otficial 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.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
.e_:2
IALE ,TURE
0 1 SIG"A DATE
SIGNATU (0 A DATE SI NED
(425)
0 VX�u
771-0220
By
Ar%NTION/
Off 1333
IT IS UNLAWFULTO 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
PERMU # L-ADB#_DATE rSSPECTJED___t&!d,()-J'
DESCRIMON OF WORK TO BE INSPECrED
A field Inspection was conducted to determine final compliance with approved plans.
Huai approval
denotes that -there arc no objections from the above signed Department. to
the release of
PERFORMANCE BONDS and the granting of:
. . .
. .
. . . . . . . .
- GRANT. FINAL PROJECT APPROVAL
GRAM MAL PROMC*r "PROVAL
R&INSPECM OUTSTAMING LSSUES
DaW Sign,
-t=3p.-bk1g:fb=s10i01
ocWddocl.