20030238.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAMEgABUSINESS
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MAILING
CITY
ZIP TELEPHONE
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NAME
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NAME r
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ADDRESS
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ZIP 1 3 TELEPHONE
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SjkTE UCENSE NUMBER EXPIRATIOP DAIE CHECKED BY
PROPERTY -TAX ACCOUNT. PASCEL NO.
NEW
RESIDENTIAL 0 PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
1 1:1 CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE X
CYDS FI)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAJNING WALL
ROCKERY
FIRE SPRINKLER
FIREALARM
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UMBER
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HEAT SOURCE GLAZING % I LOT SLOPE %
PLJkN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ORLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) VALL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISODAYS
PERMIT ILIMIR 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 INDIRECTIY
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 CRYS ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY 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
WORKMENS COMPENSAT19�ASU=D RCW 18.27.
SIGNAI&k—J41NER OAkGE") /, - J 41' 1 DATE SIWED7
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP proved
RW Permit Ro"Ired
Street Use Permit Roq'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES C3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
MUST BE PRESENT FOR
WEFIjet.q BRIE-MOVAL, OR CAP DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADB# I INSPECTION 1$ BOND
REO'D POSTED
13YES 13NO
$EPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED
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LOT COVERAGE I REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED I FRONT SIDE REAR FRONT UR SIDE REAR
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PAR LOT AREA PLANNING REVIEWED BY DATE—
IKING CL
REOD PROVIDED I I
CHECKED BY
SPECIAL INSPECTION
REQUIRED [] YES
GROUP
OCCUPANT
LOAD
REMARKS 2
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0
$ 1
-
Description
FEE
D Sicr'pt'OnT
ESurcharge
FEE
Plan Check
State
Building Permit
City Surcharge
6-
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Aml].DujeZh—_-
Recording Fee
ta2
CALL
FOR INSPECTION
(42�5)
771-0220
EXT 1333
APPLICATION APPROVAL "
This applicatilon Is not a permit unfill signed by the
Building Official or his/her Deputy: and Fees are paid, and
- receipt is acknowledged In space provided.
01 1 kL,* S119NJURE DAY
44"1619" �J& V7/i
REI.IfAdCD BY /DATf
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLON- 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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DATE RECEIVED
-N_1W ERMIT EXPIRES
ly 1 FP
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERIVII a i licAnom JOB I SUFTE/APT#
OWNER NAMEMME-W BUSINESS
MAILING ID jei_k V P/u S
1,5P 02 M ,�A/
CITY ZIP TELEPHONE
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L-L a).a
NAME
ADDRESS
CITY
NAME r CBL #
ADDR
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CITY _T ELEPHONE -7
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ST4&TE LICENSE NUMBER EXPIRA 0 E r CtECKED BY
FILCOCI�aj'69iW or�j
Wr�
j PROPERTY TAX ACCO PAPJ)CEL NO.
02AA V
-7e" . ligiff f
NEW RESIDENTIAL 0 PLUMBING / MECH
ADDrrION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMOD EL MULTIFAMILY SIGN
REPAIR GRADING CYDS [3 FENCE X FT)
DEMOUSH TANK OTHER
[3 GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY LAIN: FIRE ALARM
(TYPE OF USE, BUSINE88 OR ACTIVEM Exp
NUMFIEZ/ I CRMCAL
NUMBER OF
OF DWELLING AREAS
Tommys- g- , - , UNITS NUMBER
D6CRIBE WORK TO BE DONE
W- "OF -JWA ra
HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIIZIES ONLY THE WORK NCYTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIIVEWAYS, MMQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPUCATIOW ISODAYS
PERMIT LIMM I YM - PROVIDED WORK IS STARTED WITHIN leg 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, 17*8 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 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECTAND 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
WORKMEWS COMPENSATIOINI&SURANr
_.,kAND RCW 10.27.
ADDRESS 0- 1
L�
z
PLAT NAME/SUBDIVISION NO.
—V
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
RW PwrrA Required
Stm*t Use Perrilift RKV
EXISTING — PROPOSED—
I-pection Required
Sidewalk Required
REQUIRED DEDICATION—
FT
Undwipround
WWg required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
TANK
REVIEWED BY
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINEOR�� INSPECTION 1$ BOND
REO'D POSTED
13YEs 13NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED , PROPOSED I ALLOWED . PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
PARKING LOT AREA FLANNING REVIEWED BY DATE
REO`D I PROVIDED I
CHECKED BY ITYPE Of CONSTEILICTION E OCCUPANT
.� imk� 127 GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [ LOAD,
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ�'D
$
Ew
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. - Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapainsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
IA-3
771-0220
EXT 1333
APPLICATION APPROVAL
This application Is not a pennit Until signed by the
BuUdIng OfftW or his/her Deputy: and Fees are paid, and
ocelptisd&nowledged Insparo provided.
oil I SIGMURE DATE
R-ELgAIJED BY /DATY
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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