20030237.pdfM
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER'NAMEINAME OF BUSINESS
ADDRESS
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CITY
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NAME
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NAME
ADDRESS
CITY
ZIP TELEPHONE
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ELEPHONE
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ZIP
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
TELEPHONE
USE
ZONE
JOB
ADDRESS
I PERMIT EXPIRES
PERMIT &0,;2
NUMBER -2,
I 0a
PLAT NAME/SUBDIVISION N
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
RW PerniA Required
Street Use Peffnit Wd
EXISTING - PROPOSED
Inspet:tIon Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
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YES[3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE W
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VARIANCE OR CU SHORELINEORADBO I INSPECTION I BOND
EXPIRATION DATE REO'D POSTED
I YEs ONO $
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[] NEW
RESIDENTIAL
0 ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
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GRADING CYDS
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TANK
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CARPORT
ROCKERY A
(TYPE OF USE, BUSINESS OR
NUMBER
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OF .J�W
DWELLING
STORIES
UNITS .32
DESCRIBE WORK TO BE DONE
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,
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FRONT URSIDE REAR
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0
JOR
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SIGN
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REMARKS
o OTHER
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0 FIRE ALARM
CHECKED BY TYPE OF
CRITICAL T
AREAS SPECIALINSPECTION A
NUMBER REQUIRED [3 YES
OCCUPANT
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LOAD
REMARKS I
PROGRESS INSPECTIONS PER U13C 1108/FINAL INSPECTION REG'O 9
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VALUATION
$ �4.. X_
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK N!03 VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
11__ BE DONE ON PRWATE PROPEMY ONLY. AM CONSTRUCrION ON THE PUBILIC
23
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: 180DAYS
PERMIT UMrf I YEAR - PROVIDED WORK IS STARTED W11THIN 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 It W,,--
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 ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODINFY, WAIVE OR REDUCE ANY RSQUIREMENT OF ANY CITY ORDINANCE
Landscapainsp.
Total Amt. Due 10
NOR LIMIT IN ANY WAY THE Crr1rS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
5 F �
Recording Fee
Receipt # a2,
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-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE D THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or hi9ihor Deputy: and Foos are paid, and
IN VIOLATION OF THE LAPkTHORIZE
RC aE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In spptqprovided.
URE
WORKMENS COMPENSATIqWftVU VCE AND RCW 18.27.
0 GIG E DATE
SIGNATURE (OWNER OR19E"_./ DATE SIGNED
(42�5
_0/�
771-020!20
RELEAQED BY DATE
AWENTION
M 1333
�fl_
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINI�JLE YEdaV - 14SPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
N
CAP to 10
CITY OF EDIVIC
CONSTRUCTION PERMIT
OWNETNAMEINAME OF BUSINESS
L
MAILING ADDRESS
20o 0
CITY ZIP TELE
Eel liv? 01
NAME
1-a F0
ADDRESS
L16 P.,(f, 0; 5( (.1
CITY ZIP
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NAME
ADDRESS
q/-Z& A
PCITY ZIP
ST�; LICENSE NUMBER
-rfi,T 5-1—C V q / / V 1.)
PROPERTY TAX ACCOUNT PARCEL NO.
DATE RECEIVq
06 PERMIT EXPIRES
ZONE PERMIT /&
IDS NUMBER 03 -
JOB
IPLICATION ADDRESS I1UITF
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PLAT NAME/SUBDIVISION NO. NO. LID NO.
LID FEE$
TttK;r ppprovod
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit ReWited
Street Use Parrith Req�d
lnspecW Requwed
)NE EXISTING — PROPOSED SidewalknRequired
Under�
,.4_
REQUIRED DEDICATION— FT F 13
RES
METER SIZE LINE SIZE NO. OF FIXTU PRV REQUIRED
YES E3 NO 0 Z
-73 1 -
bg REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
L05_-77q-0550
I CBL #
z
TELEP40NE
EXPIFMTION DATE I__7Z �C
NEW RESIDENTIAL
ADDITION, 'COMMERCIAL
a-Rq mopm� I mutTIFAMILY
&IREPAIR- GRADING ms
D EM 68H TANK
13GARAGE RETAINING WALL
,"CARPORT ROCKERY A
__(e n
"E 01� USE. BUSINESS OR
NUMBER' 'NUMBER OF
OF DWELLING
STORIES UNITS
'DEScRISEr K�TO BE DONE
41�jtfio 11 e- Adf.e!�
4A '1A J 4 C-e
HEAT SOURCE
PLAN CHECK I
PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
[3 FENCE
( FT)
o OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAIJ
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
REVIEWED
DATE
FIRE REVIEWED BY DATE I I
r
VARIANCE OR CU
SHORELINE OR ADBN
WSPECTION
I
BOND
F REO'D
POSTED
13YEs 13NO
is
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
PARKING
LOT AREA
PLANNING REVIEWED BY DATE IL
REO'D I PROVIDED
REMARKS
it
CHECKEMBY
ITYPE OF, QNSTRUCTION'.
OCC
V.,
SPECIAL INS P ECTION
OCCUPA ' NT.
JAREA
REQUIRED
LOAD
REMARKS
PROGRESS INSPECT]IONS PER UBC I 08/FINAL INSPECTION RECVD
$
Description FEE Description FEE
Plan Check State Surcharge
City Surcharge
Building Permit
Plumbing
U 1 ;
I
Mechanical
THIS PERMIT AUTHORMES ONLY THE WORK NOTED.
THIS PERMIT COVERS WORK TO
t:
13E DONE ON PRIVATE PROPERTY ONLX ANY COP
STRUCTION ON THE PUBLIC
Grading
X DOMAIN JCURSS, SIDEWALKS, DRIVEWAYS, MAR
allCES, ETC.) WILL REQUIRE
SEPARATE PERMISSIC
4.
Engr. Review
PERMITAPPLICATIOPt 1804
IL
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED
WITHIN 160 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MOR�
INFORMATION
:IRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit 105-
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, H
IN INTEREST; AGREES TO INDEMNIFY, DEFEND AN[
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYS
HOLD HARMLESS THE CITY OF
S. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE.,
LRISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE
91 DEEMED 110 MODIFY, WAIVE OR REDUCE ANY REOUR
OF THIS PERMIT $HALL NOT BE
EMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE
ANY ORDINANCE PROVISION.'
CATION; THAT THE INFORMATION
FE
Recording Fee
Receipt #
.aL
APPLICATION APPROVAL
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS AAPP
GIVEN IS CORRECT' AND THAT I AM THE OWNER. OR
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STA
E DULY AUTHORIZED AGENT OF
LAWS REGULATING CONSTRUC-
H L
CALC
1;, this application is not a parF A until. signed by the
TION: AND IN DOING THE WQBKAUTHORIZED THERE
OF THE STATE
NO PERSON WILL BE EMPLOYED
F WASHINGTON RELATING TO
Building OtficlW or hWher Deputy: and Fees are paid, and
FOR INSPECTION r"pt Is acknowledged spil4provided.
IN VIOLATION OF THE LAB6R CDkE
JEJ
WORKMENS COMPENSATI URAVCE AND RCW 18
7.
DATE SIGNED
03
(4 15
-in
0 SIG E DATE
AME
GIGNATUR- (OWNER OFI,0EN"7)./
771-0220
RELEASED BY DATE
ATTENTION
EXT 1333
2
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IT IS UNLAWFUL TO USE OR OCCUPY A BU
DING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE A
D APP ROVAL OR A CERTIFI-
ORIGINijLE YEI I OW - 11 �,TOR
CATE OF OCCUPANCY HAS BEEN GRANTE
. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 P
GREEN - ACCOUNTING
ESS HARD -YOU ARE MAKING 5 COPIES
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