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DATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBERC'�&9,j
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION 1ADDRESS �Zil 17 1 94< tyl x "a 1 " ')
OWNER NAME/NAME OF BUSINESS
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NAME
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NAME
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
TIESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET M17AP
RW Perrnit Required
Street use Peffnit Roq'd
EXISTING — PROPOSED
Inspection Required
Sidewallit Required
REQUIRED DEDICATION—
FT
under
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METER SIZE
LINE SIZE
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I NO. OF FIXTURES
PRV REQUIRED
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YES E3 NO 13
REMARKS
VOWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE,
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LICENSE NUMBER EXPIRATION D TE
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PROPERTY TAX ACCOUNT PARCEL NO
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NEW ji(RESIDENTIAL
PLUMBING MECH
ADDITION COMMERCIAL
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REMODEL MUL11FAMILY
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0 DEMOLISH [3 TANK
OTHER
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FIRE SPRINKLER
FIRE ALARM
PORT ROCKERY
(TYPE OF USE. BUSINESS OR rN. " EXPLAIN.
NUMBER NUMBER OF
OF DWELLING
CRITICAL
AREAS
STORIES UNITS
NUMBER
DESCRIBE WORK TO BE DONE
ENGINEERING REVIE
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FIRE REVIEWED BY
H7URCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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=IS PERMIT AUTHORrzEs ONLY THE WORK NOTED. THIS P RMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANy CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPUCATION: ISO DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 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 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 CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
bes
I HEREBY ACKNOWLEDGE THAT I 14AVE 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 LAMB CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS RANCE AND RCW 1 8.27.
SIGNATU19 (OWNER 0 DATE SIGNE4
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REMARKS
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REMARKS 2
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG' d
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire inspection
Landscapelnsp-
Fee
FEE
F�E#EDescrlptlon L.
State Surcharge
City Surcharge
CALL
FOR INSPECTION
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771-0220
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Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisfher Deputy: and Fees are paid. and
receipt Is acknowledged in space provided.
FFICIA)/S
,fGNYYR
DATE
By
ATTENTION Llaq)y
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL �AI41,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLON-I&SPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
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DATE RECEIVED 0-3 1
PERMIT EXPIRES
USE PERMIT&,,._
ZONE 0 � S
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB tt��11 I.% S q .tll A SUITFIAPTO
OWNER NAMEINAME OF BUSINESS ADDRESS VC ---
0 A\1 t-7- r? I PLAT NAME/SUBDIV1SION NO. LOT NO. LID NO.
UT �_j
MAILING ADDRESS
2 -3 (o
CITY ZIP TELEPHONE
4�i�o,maq,ep z6j 2/ x 00,7 & 2,
NAME
C—F �/ &
ADDRESS —4 Is
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CITY ?5Z I TEL PHONE
_0A,jiDA-)05 7 __7,7/ 335
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPruvfd
AW PaM91 Rewired
street Una Permit P401
EXISTING — PROPOSED
Inspectlor' Requirec!
Sidawak Required
REQUIRED DEDICATION— FT
Underground
Wiringrequir"
METER SIZE LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 NO 13
FOR EROSION CONTROUDRAINAGE
WRjRESPONSIBLE
N
NAME ICBLN
CBL
<!51' —A-)&
. ENGINEERING REVIEWED BY DATE
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ADDRESS f I ±1 -1 10
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FIRE REVIEWED BY DATE
F
W.
CITY ZIP 4TTELEPHONE
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHACKED BY RE POSTED
.-ap 13Y Qik 1$
clop ES 0
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SEPA REVIEW SIG N AREA HEIGHT
9PROPERTY
TAX ACCO PARCEL NO. I COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROP03ED SETBACKS (FT.)
WIN E H i
N EW RESIDENTIAL 1:1 PLUMBING MECH ALLOWED PROPOSED FRONT SIDE BEAR FRONT LIRSIDE REAR
MPLLANCE OR
C 0 PU 0 R
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ADDITION COMMERCIAL 1:1 r: OF USE 3 5f, Z. -7,9 15 1 '72
CHANGE .
PARKING LOT AREA PLANNING REVIEWED BY DATE
0 REMODEL MULTIFAMILY 0 SIGN RECID PROVIDED
061
1 4
2. 2- 11060 4-1a e
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0 FENCE _04
0 REPAIR 0 GRADING CYDS X FTI REMARKS
OTHER
DEMOLISH 0 TANK
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0 GARAGE RETAINING WALL FIRE SPRINKLER
"CARPORT 11 FIRE ALARM
ROCKERY
(ME OF USE. BUSINESS OR ACTWITY) EXPLARY CHECKED BY 11TYPE OFVUCTION OCCUPANT
GROUP L)
"NUMBER NUMBER OF CRITICA k OCCUPANT
DWELLING AREAS SPECIAL INSPECTION JAREA
.OF
STORIES UNITS NUMBER REQUIRED LOAD
YES fj2 &S rZ
I
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REG'D
x ON
VALU 'n
Description
FEE
Description
FEE'
Plan Check
State Surcharge
HEAT S RCE GLAZING % LOT SLOPE %
.qU Building Permit
a*;el T
City Surcharge
1-1/
PLAN CHECK NO: 0 VESTED DATE Plumbing
Mechanical
THIS PEMrT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLZ N41� CONSTRUCTION ON THE PUBUC Grading
:3
DOLWN (CUR13% SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
k:
SEPARATEP ISSION.
E I
Engr. Review
a
PERMffAPPUCA1"6N: 1W�AYS
PERMIT ILIUM I YEAR - PROVIDED WORK 18 67ARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"A0PLICANIT, 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, WASHINGTOft ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY MD
'Fire Inspection
Receipt #
" CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRlic-my OR INDIRECTLY
FROM THE ISSUANCt'OF THIS PeRurr, ISSUANCE OF THISPERMIT. SHALL NOT BE
DEEMED TQMODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE crty.s,.ABWY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
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
EMPLOYED
CALL
This application is not a permit Until signed by the
Building oMcial or his/her Deputy: and Fees are paid. and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE
IN VIOLATI N OF TH STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknov&dged in space provided.
WORKMENS E RANCE A14D RCW 18.27.
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DATE
OFFIC N IALS �PGNV7.
S NATU( (OWNER 0
IG
DATE SIGN
0 75
771-0220
(1, 1 A
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IA_E-1QjSED BY DVfE
ATTENTION q* ?_ 57 71 Off 1333
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IT IS L N' AW '0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
- - - - - , #
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
-
-V OR GINAL - FILE - YELLOW - I SPECTOR
.1�1�0
INK
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
P -OWNER - Got n - ASSESSOR
GREEN - ACCOUNTING
01102 /Z(414()gnjW,,PRES HARD -YOU ARE MAKING 5 COPIES
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