20030361.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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EXPIRYION DATE
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PLAT NAMEISUBDIVISION NO. LOT NO.
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LID NO.
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STORIES 17rl 8 NUMBER
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HEAT SOURCE ING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PFRMITAPPUCATION: 160 DAYS
PERMIT LIMM I yEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICAN"L 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE REA13 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 REGULNrING CONSTRUC-
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
WORKMENS S2!!:!!!2�=NCE AND RCW 18.27.
DATE SIGYED
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FIRE REVIEWED BY
DATE
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION] BOND
REO'D POSTED
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RECID I PROVIDED
REMARKS
CHECKED BY I U 5�6&i -A
SPECIAL INSPECTTIONAREA OCCUPANT
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'Oj is
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Description FEE Description FEE
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State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION AdVAL
CALL
This application is not a permit until signed by the
Building Official or histher Deputy: and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged In space provided.
(A13
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771-0220
—RELEASED BY DATF/
A'17TENTION
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
BC SECTION 109 PINK -OWNER GOLD -ASSESSOR
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DATE RECEIVED
I U I PERMIT EXPIRES
CITY OF EDMONDS
us PERMIT
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS2
OWNER N VT BUSIVEP
A r 1,P 4-
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS r
loe - 9).
LID FEE
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Permit Raquirm
Use Permit Req'd
ctry ZIP TELEP HONE
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EXISTING PROPOSED w4metion Required
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UnderWound
REQUIRED DEDICATION— FT Wiring required 13
NAME
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METER SIZE LINE SIZE 1-70, OF FIXTURES PRV REQUIRED
YES 13 NO 13
ADDRESS
IOWNER/CONTRACTOR
REMARKS
RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY My ITELEPHON
NAME BL N�M
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ENGINEERING REVIEWED BY DATE
ADDRESSF
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STTALICENSE NUMBER EXPIR9101i DATE
VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
REO'D POSTED
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PROPERTY TAX ACCOUNT P
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SEPA REVIEW SIGN AREA HEIGHT
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REMARKS
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SHIP
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CHECKED BY 1=7 TF7-
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
�A'
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
0 rn
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONfLPER LIBC IGO/FINAL INSPECTION REQ'D
C
aA
VALUATION
$
Description FEE Description FEE
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0
Plan Check State Surcharge
I
HEAT SOURCE GLA23NG % LOT SLOPE %
Building Permit City Surcharge
0
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PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
h BE DONE ON PRIVATC PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOUAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMIGSIOIL
Engr. Review
PERMIT APPUCiTION: 1W DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 19 STARTW 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
--- .01—
Fire Inspection Receipt #
7
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC71Y OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
HER'
APPLICATION APPFkOVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
GIVE"
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
E
CALL This app,11caflon is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building QfflcW at hieftr Deputy: and Fees we paid, and
FOR INSPECTION reoelpt Is acknowledged In space provided.
LIN
WOR�MEITS C CE AND RCW 18.27.
re
FICIAL 0 URE D TE
Q!_
SIGNATUVIWFR DATE SI ED
W
;TE
1A135)
k'
771-0220 —RELEASED
BY DATV
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL,INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW- INSPECTOR
PNItbF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING