20030390.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS - �0 10
MAILING ADDRESS
CITY ZIP TELEPHONE
OF
Od
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
ADDRESS
C" J ZIP TELEPHONE
STATE LICENSE
PROPERTY
0
NEW
�JrRESIDENTIAL
0
ADDITION
0 COMMERCIAL
0
REMODEL
0 APARTMENT
0
REPAIR
0 GRADING CYDS
0
DEMOLISH
'CWJTANK
o
GARAGE
RETAINING WALL
CARPORT
(TYPE OF USE, BUSINESS OR ACTW7M4XPLAIN:
NUMBER
OF DWELLING
NUMBEROF
STORIES UNITS
DESCRIBE WORK TO BE DONE
;0(61
0
PLUMBING / MECH
o
COMPLIANCE 08
CHANGE OF USE
0
SIGN
o
FENCE
FT)
0
OTHER
0
RENEWAL
W
USE
ZONE
inn
ADDRESS.,,�
PERMIT EXPIRES L.4ZI flfli.-Z
NONE
PERMIT V
NUMBER 0
SUITE/APT#
1100000
PLAT NAM E/SU BDIVI SION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pentrin Requited
Street Use Permit Req'd
EXISTING - PROPOSED
Inepection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES C3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAUL:
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADS#
SIGN AREA
ALLOWE[r,I[ILD
PARKING LOT AREA I PLANNING
REO'D I I I
REVIEWED/DATE
DATE
INSPECTION I BOND
REO'D POSTED
YES C3 NO
HEIGHT
PlAt ED I PROPOSED
DATE
0
z
ix-
W
1�
'n,
W
V.
Ln
z
1
IL
CHECKEDBY IT] N I CJE
D OCCUPANT
CRITICAL GR / L
AREAS SPECIAL INSPECTOR JAREA OCCUPANT
NUMBER /V/P REQUIRED [] YES LOAD
2U I
tREMARKS
z
P p 0
ROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
0,
a
VALUATION I FEE
PLAN CHECK FEE
GLAZING % LOT SLOPE % BUILDING
HEAT SOURCE
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 GRADING/FILL
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
It VffE SURCHARGE 100�
x /57
5 PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION 0;162 9:
RS WrS9LCfeNfF1E Y Ve(� 11111V
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESO
5 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEIPT
DEEMEDTOMODIFY, WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
C NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.. RECEIPI-Z�?
TOTAL AMOUNT DUE
fHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
H' 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- This application is not a permit until signed by the
T T CALL
ION; 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 acknowledged in space provided.
C
WORKMEN'S COMPENSATI CE AN9 RCW 18.27. OFFICIALS SIGNA7TUE D TE
DATE SIGNED,
j A &11101A z YZ
SIGNX1I 1: 111, 1: � I lg;:GE?N e� 425) It"
771-0220 AWL=' DAfE
REL`EASEb'&'
AfTEN'TION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STR CTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
5/98
FINAL PROJECT APP.RDV--A.L FORM
TO:
z
9
0
m
:q:fi
Vi -=-':
ma
0
80
a
—1 r.
MM
MZ
n
I
M
M M
a Vi
0
0 Fn
C co)
M (1)
M 0
M
z
V)
z
9
0
m
FARM FINAL INSPECTION - OUTSTANDING ISSUES
a' Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Si
ocaprvLdoc.l:temp:bldg:formsIO/OI
1§
iF
o
$Tj
24
0 A
cl�
-- ---- -----
IDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS .0 1
MAILING ADDRESS
, zy— Z: -5- 4:;?A i K S - � �' -
CITY ZIP TELEPHONE
7 0'1r.-
NAME
ADDRESS
CITY ZIP TELEPHONE
NAME
M
ADDRESS
9-1* .'7 '-j j ZIP TELEPHONE
0 NEW
r)a,--FIESIDENTIAL 0
PLUMBING / MECH
0 ADDITION
0 COMMERCIAL o
COMPLIANCE OR
CHANGE OF USE
0 REMODEL
0 APARTMENT 0
SIGN
0 REPAIR
0 GRADING 0
FENCE
CYDS
X
( FT)
0 DEMOLISH
VIV-TANK 0
OTHER
o GARAGE
RETAINING WALL 0
RENEWAL
z
CARPORT
ROCKERY
E(TYPE
OF USE� BUSINESS OR AC
rc
'NUMBER
MPLAIN:
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
1 0
STORIES
UNITS
NUMBER
IVI
DESCRIBE WORK TO BE DONE
USE
ZONE
JOB
ADDRESS
PERMIT EXPIRES
PERMIT
NUMBER
4 X,
_"WER-290
2
SUITE/APT#
PLAT NAM E/SU BDIVI SION
0.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW Permit Requited
0
0
street Use permit Roq'd
0
EXISTING — PROPOSED
Inspection Requited
0
Sidewalk Requ"d
E3
REQUIRED DEDICATION— FT
d"' oun
UW71dritfirecluldmd
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 No E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE W
M
M
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
REO'D POSTED
C3 YES 0 NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED , P ROPOSED
EXP
LOTCOVERAGE s REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
E AAAFIRWAR I
PARKING A4LM1rFgM I PW
. eftftED 13Y DATE
REa'D I PRQVID NT CAD
CHECKED BY ITY ON OCCUPANT
GROUP
SPECIAL INSPECTOR JAREA OCCUPANT
REQUIRED[:] LOAD
�EMAR`Kg 0
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RtQ'D
j '
VALUATION
FEE
N
PLAN CHECK FEE
PL A C H E
HEAT SOURCE GLAZING % LOT SLOPE % BUILDING
13U I LD IN G
PL U M B I N C
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
RADING,
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADINGIFILL
SEPARATE PEZISSION. )i
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 'tNG RE IEW FEES
VffE SURCHARGE
E SU
IT APF6L1Ce16,N Avg
PERMIT IJW,9�6 - PROVID ORK RTED WITHIN, DAYS
Arp 0 V
t:
9 'APPOCANY'011140ZLO�fjli��ER SP6LISE. HEIRS, Zgf�`NS AND SUCCESORS
I IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
a EDMONDS. WASHINqTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
S
F
D S
T
Ro
U
HE
M
CC
C
AN
E
T
Y
S
I Y
0
A
R
0
N
S
F
D
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 08 INDIRECTLY RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
11
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
IS
NOR LIMIT IN ANYWAYTHE CITY'S ABILITYTO ENFORCE ANY ORDINANCE PROVISION., RECEIPIa/
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
Z T 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- This application Is not a permit until signed by the
LL 13 MPLOY CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE AEMPLOYED Building Official or his/her Deputy: and Feesaro paid. and
IN VIOLATION OF THE LABOR Q9DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space pravload.
WORKMEN'S COMPENSAT 2!!nN CE AN RCW 18.27.__ O�FICIALS SIGNATURE Di
SIGNATURE G VEN DATE SIGNED '425
"bIlh%A
_V/1 IV
771-0220 RECEASEb(EK'
'0 /.DiE
o—
'16M 1. as p.
ATtEkTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRZTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 ORIGINAL -FILE YELILOW- INSPECTOR
PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX