20030233.pdfPERMIT EXPIRES
RECEIVE11 I
CITY OF EDMONDS
USE PERMIT
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NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS -4-tq Z-T 10 1 �>l T SUJ
OWNER NAMEINAME OF BUSINESS
55 0 Ai 4
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE S
TESCP Approved
Iq as 3L.-A—D
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required
Street Use Permit Raq'd
0
CITY ZIP TELEPHONE
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EXISTING — PROPOSED Inspectio Required
SidewalknRequLred
L4Z) I 0A S33
REQUIRED DEDICATION— FT Undwgrowd
wiringioquired CI
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I YES13 NO 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
ORE PAAR8HA6
MUST RE PBESEN. EOR
NAME CBLN
TANK FILL, REMOVAL, OR CAP
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ENGINEERING REVIEWED BY DATE
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ADDRESS
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CITY ZIP TELEPHONE
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FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER% EXPIRATION DATE C ED 11
REO'D POSTED
113YEs IS
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13NO
6
SEPA REVIEW SIGN AREA HEIGHT
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COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP , ,
NEW WoeRESIDENTIAL PLUMBING if MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
COMPLIANCE OR
0 ADDITION [j COMMERCIAL CHANGE OF USE
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PARKING LOT AREA REVIEWED 13Y DATE
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El REMODEL MULTIFAMILY 0 SIGN
rNING
RECYD PROVIDED
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GRADING FENCE
0 REPAIR El CYDS X _FT)
REMARKS
Pis OTHER
DEMOLISH -��TA N K
GARAGE RETAINING WALL FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
(TYPE OF USE, 13USINESS OR ACT
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CHECKED BY OF 49USTRUCTIOL OC UPA
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ITYPE
GROUPX_�
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECY kLINSPECTION JAREA OCCUPANT
LOAD
STORIES UNITS NUMBER
REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG-0
-A 2
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZNG % LOT SLOPE %
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Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORLZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
lz BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOMAIN (cuRss, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: 180 DAYS
IL PERMIT ILIMM 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 INDEMNIF� DEFEND AND HOLD HARMLESS THE CITY OF
3 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 13E
Landscapeinsp. Total Amt. Due
9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
PPL ATION A ROVAL
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.
Th appll n Is not a permit until signed by the
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREEN. NO PERSON WILL BE EMPLOYED
Buildi OM I or hWher Deputy- and Foos are paid, and
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IN VIOLATION OF TH CODE OF THE STATE OF WASHINGTON RELATING TO
, )4ded.
FOR INSPECTION I r pt Is acknowledged In space pro
WORKMEN'S COMP AT19AUhl NCE AND RCW 18.27.
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(OWNE AGE DAT I NE
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ZTURE
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771-0220
BY DATE
ATTENTION
_�,ASED
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
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