20030247.pdfI
DATE RECEIVED )4
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS---,--
PERMIT EXPIRES I () N6
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS �ZIZLII ':E�; _ 2j!E)L.J-- LL
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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ZIP
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REQUIRED DE0I9j,)j9,y
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NAME
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSINKARF,
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ZIP
ITELEPHONE
NAME
ADDRESS
STATE LICENSE NUMBER
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NO.
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ADDITION
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ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
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Plan Check State Surcharge I
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPUCATION: 180 DAYS
CL PERMIT UUrr 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 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a 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 PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
I HERE13Y 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 Official or histher 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 spaco provided.
WORKMENSAMPEN RA,4E AND RCW 18.27.
OFFICIALS PIGNAYJRE
U
la"TTU
MAW—
DATE SIGNED
(42-5)
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DA�E
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771-0220
RELtASEb- BIC DATIlif
ATTENTION
EXT 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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VARIANjV&j**dH%Pz=AMhftAN AT- SO
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT I ALLOWED . PROPOSED I ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED I FRONT SIDE REAR FRONT LIR SIDE REAR
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REQ`13 I PROVIDED I
CHECKED BY
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OCCUPANTd:7e:2
GROUP
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AREA
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IREMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE00
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Description FEE Description FEE
Plan Check State Surcharge I
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
. .......
PLAN CHECK NO:
VESTED DATE
Mechanical
20.
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THIS PERMIT AUTHORMFS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Iz 13E DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
so DOMAIN (CURBS, SIDEWALKS, DRIVIEWAYS, MARQUEES, ET9.) WILL REQUIRE
SEPARATE PERMISSION.
S; �l A
r. Review
PERMIT APPIUCATIONh6 WS- �—
I
PERMIT LIMM 1 YEM - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
I
;APPLICANT,
N INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAAMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
:IFReceipt
#
1z
Is
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR TH&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 Official 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 96MPEN�==E AND RCW 18.27.
OFFICIALS 9IGNAT R;��. DATE
DATE SIGNED
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(4201
/1 zj IVA--h
M-0220
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*I'IDATV
RELgAftt(BY�'
ATTENTION
M 1333
`�TOI USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
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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