20030306.pdfUAI It HLUEIVEI��j 3
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
ZZ Z 7-K C'tJ
CITY ZIP TELEPHONE
�V/4,dw0l� 51P2-01 14'2`3--,3,2 7 - ILI 7
NAME
ADDRESS
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
ZIP [TELEPHONE
_ ICBL#
ZIP I TELEPHONE
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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'-.51,7DW 00
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
0 DEMOLISH TANK
oGARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE 0 SE, BUSINESS OR ACTIVrM EXPLAIN:
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NUMBER PNUMBER OF
I
OF DWELLING
I
STORIES UNITS
DESCRIBE WORK TO BE DONE
ngtLU �111N - MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
I X FT)
OTHER
oFIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE Z' PERMIT
ZONE
NUMBEi0ft, 4VI
JOB 6 1
ADDRESS (11 / (f frl j / 3 tklj
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESGF APPMOd
RW Pernift Required
Sir or Use Partnit Reqd
EXISTING - PROPOSED
Ins= n Required
Sidewalk Required
REQUIRED DEDICATION FT
underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESD NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
V-=tO I n1P1P<jc%1J
ENGINEERING REVIEWED BY DATE
FIRE REVIEWEd BY DATE
VARIANCE OR CU
SHORELINE Oil ADBO
I INSPECTION
R Q.0'D .
I BOND
POSTED
EIYES,'%rN0
$
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
- HEIGHT
ALLOWED P?OPOSED
"XP
,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED, JPROPOSED_
FRONT SIDE REAR
FRONT L/R SIDE REAR
PXRKING
LOTAREA
LANNING REVIEWED BY DATE C*'
LP 06
REQrD
I PROVIDED,
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99AUD'" I S srojz'r 4t 7>&
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CHECKED BY ITYPE 0!!T
JQTION UrANY j ,M%
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CRITICAL OC
AREAS SPECIAL INSPECTION jAgEA CUPANT
RUM— -Wig LOAD
Lj YES
REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REG'D
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Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check 1 31 State Surcharge q,so
Building Permit City Surcharge
1 3601-
PLAN CHECK NCkk-,%
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DATI
0
Plum bing
-D
L2L(2—�T
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
t
Engr. Review
PERMIT APPLICATION: 180 DAYS
00—
CL PERMIT UMFr 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
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due]
Y�
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt it
111113
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 WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or histher Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
WGaKMEN'SfA"SATIO�,�URANCE AND RCW 18.27.
0 1 A NAT DATE
SIG, =(OWN R
DATE SIXED
(425)
771-0220
RELE ED BY DAft
kTTWION
FM 1'333
A AIA.41
I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW -IAPECTPI�
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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2003
SFERNIGES
CITY 0, L-,,�MIAIIDS
WA
FINAL PROJ9CT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE--,
nzmsm
ENGINEERING DIVISION DATE
-PLANNING DIVISION DATE,
PROJECT,
SITE ADDRESS..
PERMIT 42 ADB#_______---PATE INSPEYTED_4&1_[/X_4
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DESCRIPTION OF WORK TO BE INSPECT
-approv d
A fleld ins ection was conducted to determine compliance with e plans. Final, approva
denotes.,.that there are no objections from the above signed Department to the release of
PERFQRMANCE BONDS.and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT AppRovAL WrIH CONDITIONS NOTED
ONDITIONS given to owner/contractor by inspector
0 Copy of C
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbmis:ocaprv1 3/25/04
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