20030382.pdfI
PERMIT EXPIRES 7701 G�
USE PF:I*UIT
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
Faic, &,s4-afsopl
MAILING ADDRESS
1h Awt N
CITY ZIP TELEPHONE
edmON16 wo, loozo Yzi-171 5C64)
NAME
DATE RECEIVED
ADDRESS
CITY ZIP ITELEPHONE
NAME ICBL#
ADDRESS &ZI-122 lab
0/t-�
CITY
/
TELEPHONE
(5
STATE LICENSE NUMBER
EXPIRATION DATE
I CHECKED ZY
NO.
NEW
RESIDENTIAL
1:3 PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
13 CHANGE OF USE
REMODEL
MULnFAMILY
1:1 SIGN
REPAIR
GRADING CYDS
[3 FENCE X
F7)
DEMOLISH
1:1 TANK
o OTHER
oGARAGE
o RETAININGWALL
FIRE SPRINKLER
11
CARPORT
ROCKERY
FIRE ALARM__
(rYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
HomC
NUMBER
NUMBER OF
C RITICAL
OF
DWELLING
AREAS
I
.STORIES
UNITS
NUMBER
DESCRIBE WORK TO
BE DONE —
A. .
1) windev$ 66 W-11 As-
- A . a
see -
HEAT SOURCE GLAZING % LOT SLOPE %
& A.S I I
PLAN CHECK NO: I VESTED DATE
ZONE JV
NUMBER t 0
J013 E/APT#
ADDRESS C, rf"\ Avc, K!
PLAT N /SUBDIVISION NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP
RW Permit
street use Permit Fleti'd
EXISTING — PROPOSED
Inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION— Fr
_Z_
Underamund
Wiring required [3
METER SIZE
LINE SIZE
0. OF FIXTURES
PRV REQUIRED
YES 13 NO .13
REMARKS
z
OWNER/CCINTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
A
4
BY DATE
FIRE REVIEWED BY DATE
VARIAN05Q�ORELINEORADB# I INSPECTION 1. BOND
REO'D POSTED
E3YEs 13NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLO PROPOSED ALLOWED PROPOSED
EXP -1 1
LOT COVERAGE REQUIRED SETBACKS (F;Nt
r.) fQROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR NT LIRSIDE REAR
LOT AREA I PLANNING 1 0 BY
PARKING
REO'D I PROVIDED
CHECKED BY TYPE MIRUCT"ll OGE;U
I I cef —+ GROUR3
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
REQUIRED [3 YES
REMARKS
PROGRESS INSPECTIONS PER UBC 1101111MINAL INSPECTION REG'D 9
I pa
' I �L�u I- -
DescriplJon -FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge 156U
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTV ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2
3 DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
CL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Fnjjr lnspacuw
(0-5
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANL ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Plan Chk. DeWposit
an C
FRRIecelpt
'51—_
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-Irm r .
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
#
"U f 01
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 OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
-
Recording Fee
Receipt #
ZZ--JL R
I HERESY 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 C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a perrinit 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknovAedged in spa9provided.
WORKM N' C __ N�,ATION INSURANCE AND RCW 18.27.
(425)
� i _ / JE
0) C IGN77E 9�7;a
J'A Q�
DATE SIGNED
771-0220
I
fE7'y
idl
L DATE
�17
ATTENTION
EXr 1333
t
;T-5o i
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
'D -
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
k
z
0
1
0
M
M
C
M
2
M
M
C 2
0 In
In
M M
Fn
C
0
z
0
M
(00)
ral)