20030319.pdf13
DATE RECEIVED
'1� "3 [ PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER )00
CONSTRUCTION PERMIT APPLICATION JOB .119 011 - SUITEIAPT#
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PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVIEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: 160 DAYS -
CL PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;AP CANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
N I%REST. 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 Pon DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
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DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR umrr IN ANY WAY 7HE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Be Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND L
THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVA
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit unfill signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED CALL Building Official or histher Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOPM RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATI(ff _'�DE OF THE STATE OF WASHINGTON
��ANCE AND RCW 18.27. 1 OFFICI�L� SIGNffURE D TE
BIG OWNER OR A 111112
LDATE SIGNED 1,25
771 -02 DkT_E
20 RELEASED BY
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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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY
NAME
ADDRESS
CITY
ZI
P TELEPHONE
ZIP ITELEPHONE
PERMIT EXPIRES
IUSE PERMIT
ZONE NUMBER
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO.
SUIMAPTO
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Z17TELEPHONE
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STATE LICENSE NUMBER
e -7 3 414 6 7--, 1,v;
EXPIRATION DATE
-�) 1-7 11)
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Ly I " -T-77--L U zz) - (I.) I
NEW RESIDENTIAL
0 ADDITION COMMERCIAL
0 REMODEL MULnFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
CARPORT
[3 RETAJNINGWAJ-L
ROCKERY
frYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN; -
I 15rk
lWe B or L vent conn=Lum
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unbeated spaces. UMC 815.1.7
FIRE Ul
GAS PIPE TEST MUST BE
BOND
VARIANC(M POSTED
nA% JONOI
SEPA REvi iFf ID HEIGHT
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COMPLETE XEMPT lg� �_.D ALLOWED , PROPOSED
EXP I I I
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PLUMBING / MECH ALLOWEDA AIM
COMPLIANCE OR
CHANCE OF USE SHALL M - IN-Q'rA Ir
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PARKING Y DATE
SIGN REO'D I PROVIDED T"ft A FF
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( _ X_FT) REMARKS
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FIRE SPRINKLER LVU1LVU%W
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NUMBER
NUMBER OF
CRITICAL
OF
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DWELLING
AREAS
STORIES
UNITS
NUMBER
bESCRIBE WQRK TO Bjj
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CHECKED BY TYPE EOST(TION jc,_011_F�, OCCUPANT
GROUP )e
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECtD I
kii/7',/V j�;v z2ow;h�&,03-41971
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOUPCE ebMRt*M
/V�Fr' 6A .1 1
-Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERUrr AUTHORCMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPEM ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURB% SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION.' 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPUCMT. 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 0
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OFI THIS PERMIT SHAW NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE Crr1fS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIM 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-
t CALL
ThIsaolcallonis 'apermhuntUsIgnodbythe
' Fees are and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOXWDE Of THE STATE OF WASHINGTON RELATING TO
18.27.
FOR INSPECTION
Building 5z t4y; and paid,
,,�r,h Do P
celp klZodgo4lis space provIded.
I I
WORKMEN'S COMPENSATIIVI CE AND RCW
0 E SIGNED
14251
OFFICIALP SIONA FURE ' . I TE/
7,
:2
V DATE
771-0220 RELEASED BY
ATkTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L_
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
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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