20030301.pdfDATE RECEIVED /,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAJAE OF 13USINESS
VAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP TELEPHONE
NAME
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PRQPERTY TAX ACCOUNT PARCEL NO.
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[PERMIT EXPIRES
ZONE PERMIT
NUMBER
C,4_�,t-J I
JOB
ADDRESS lqqIq W/,t,
SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP r-ld
AW PenrkKPR,.,Vd
street use Permit Roo
EXISTING — PROPOSED
Inspection RequLrod
SIdewalk Required
REQUIRED DEDICATION— FT
underground
Wiringrectuired 13
METER SIZE LINE SIZE NO, OF FIXTURES
PRV REQUIRED
I
YESM NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
A PRESSURE REGULATORVALVE nV)
3 REOVAUDL BIB INS 170MED NEMAT
THE WATER SHUTOFF
FIRE REVIEWED BY DATE tu
Ic
I M
VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BOND
REO'D POSTED
13YEs 13NO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED .—FROP91W ]-,ALJOWED , PROPOSED
NEW
RESIDENTIAL
Pi
—Nrp"LUMBING / MECH
LOT COVE=
ALLOWED P 6#ff
.0610
ADDITION
0 COMMERCIAL
COMPLIANCE OR
LWE
B
CHANGE OF USE
REMODEL
0 MULTIFAMILY
SIGN
PARKING
REO'D PROVIDED
I I
LOT AREA
I PLANNING REVIEWED BY
0 REPAIR
[3 GRADIN13
CYDS
FENCE
X FT)
REMARKS
DEMOLISH
13 TANK
OTHER
0 GARAGE
CARPORT
o RETAININGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
SETBACKS (Fr.)
R SIDE REAR
DATE
(TYPE OF USE, BUSINESS OR ACT
CHECKE 1) BY I TYPR77
8 N OCCUPANT
0 U P
RO
NUMBER ----
NUMBER OF C CAL
OF DWELLING A R EITAI S
SPECIAL INSPECTION JAREA
OCCUPANT
LOAD
STORIES UNITS NUMBER
REQUIRED 0
YES
DESCRIBE WORK TO BE DONE Cer
REMARKS
PROGRESS INSPECTIONS
PER USC 108/FINAL INSPECTION REaD
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4
VALUAnON
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
T
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUT14ORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, FTC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLACATION: 11110DAYS
06 PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
Engr. Inspection
SEE BACK OF PIHK PERMIT FOR MORE INFORMATION
'APPLiCAN7; 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
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 ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapoinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
I#
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 his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOO CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATIPfligURANCE AND RCW 18.27.
4 -13 DATE
OFFICIS St ATURE
'kX
TURE OWNER OR E DAT E SIGNED
!!W
(425)
Z /41"
I _z -C
771-0220
!EIL '1
SED DATE
AWENTION
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
9
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
1 cig I q-
CITY, ZIP TELEPHONE
t� --x;k4.S a qo Z,(. I
NAME
ADDRESS
CITY
ZIP ITELEPHONE
PERMIT EXPIRES
PERMIT
zufJE - NUMBER
JOB
ADDRESS Zqqlq ML
SuITE/APT#
4D
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ft:SCP Appmed
AW Pam* Required
I
Street Use ParmN RWd
EXISTING — PROPOSED
lna;mdm Required
Sidevrelt Required
REQUIRED DEDICATION— FT
Underground
Or eq— CI
"m", 2
METER SIZE
LINE SIZE
I NO. OF FIXTURES
2V REQUIRED
PRV
EYES13
NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NAME CBL #
(xooa� I ENGINEERING REVIEWER -ItTAINIT TO ECDC 19-N-020
ADDRESS W APRESSLIRLAMULATORVALVE(pRVI
019 WrA133m IN&M
%-7 113- 13- FIRE REVIEWED BY -kbfg Big ! LU
CITY ZIP ITELEPHONE TM WATm SHMFF Ix
cm 12.7- 1-3zz-z000 VARIANCE OR CU SHORELINEORADB11 I INSPECTION I BOND ir
STATE LICENSE NUMBER EXPIRATION DATE C REO'D POSTED
13YEs 13NO $
6-4000SC* I H h -3-0j.
SEPA REVIEW SIGN AREA HEIGHT
PFERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ED PROPOSED ALLOWED PROPOSED
70!j 1 (:q 100-Z.0 Ll ZO I I
,
EXP
LOT COVERAGE SED SETBACKS (Fr.)
NEW RESIDENTIAL —kroplILUMBING / MECH ALLOWED PROPO X LIR SIDE REAR
RIM47
2
COMPLIANCE OR
ADDITION COMMERCIAL 1:1 CHANGE OF USE a
-
z
PARKING MPRM=RTM9qjfffffty)jW DATE
b 'REMODEL MULTIFAMILY 0 SIGN REQ`D I PROVIDED1 G
1 :3 REPAIR [3 GRADING CYDS [3 FENCE X
FI) REMARKS
DEMOLISH TANK OTHER
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
OWE OF USE. BUSINESS OR
CHECKED Y TYP"CgSON OCCUPA T)(
N/ A
irl=
GROUP
NUMBER NUMBER OF CRITICAL 41,.Z —
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
Aj+__
LOAD
"UNITS
STO IES�-+ NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE (erf?Lj( REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQD
JP. I
$
Description FEE Description FEE
Plan Check, State Surcharge
HEA!r SOURCE J77LAZING 11 LOT SLOPE %
Building Permit City Surcharge
.,7
W
PLAN CHECK NO: VESTED DATE Plumbing z
Mechanical
THIS PERMIT AUTHORIM ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I=
23
It,
2
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PEJIMITAPPLICATIOtL" ISO DAYS
PER�ff LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. Depo
'APPLfCAWrdN'13�ftLpgrMS'OR'HERWOVSE,,HEIRS, ASSIGNS AND SUCCESORS Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. [TO OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
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 CIrY ORDINANCE Landscapeinsp.
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee
Receipt #
Total Amt. Due
Receipt #
I HEREBY ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
AUTHORIZED A
GIVEN IS CORRECr AND THAT I AM THE OWNER, OR THE DULY GENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Ttds application Is not a perntit untli signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building OftW of hIs/Mr Deputy: and Fees we paid. and
IN VIOLATION OF THE LABOFLCODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt It acknoMedged in zpw* prmWed.
WORKMENS COMPENSAT"KIIJURANCE AND RCW 18.27.
OFFICI 8 SICPATURE
SIG on
DATE SIGNED
(425)
-7, ZT �2�
-Z <4
771-0220
RELEfA E
ATMNT1014
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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