20030407.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINES§
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MAILING ADDRESS
CITY ZIP
NAME
ADDRESS
CITY ZIP —ITELEPHONE
NAME ----ICBL 0
ADDRESS
11 J.
PERMIT EXPIRES
S E
SE PERMIT
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ZONE NUMBERAA�,�
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A D D RE Se
ADDRESS �Li' a
PLA T
PLAT NAME/SUBDIVISION NO.
NAME /SL
LOT NO.
LID NO,
FFEE
710 S
PU13LIC RIGHT
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP
AW Pei" Rowked
S —
EXISTING PROPOCE�D—
Strsgt Use Perynh Rser'd
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0
0
REQUIRED DEDICATION__=��_�
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WiringraqLaw 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
I
YES13 NO 13
2-9
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
STATE UCENSE NUMBER EXPIRATION DATE I CHECKED N
IROPERTY jAX AqCCALNT PARCEL NO.
FIRE REVI BY DATE LU
W!116 M
E SEWER MUST BIB CAPPED AT
OPERTY LINE
VARIANCE OR C SHORELINE OR ADS NO
R METER EDWTED
13113 WIT14
HEIG
SEPA R,EIVAI SIGN AREA HT
COMPLETE IDXEft LxqwWPrRbT?5 D D 1`0 o9ft I A BED
0 NEW
ADDITION .
REMODEL
KI'OOR'ESIDENTIAL PLUMBING / MECH
4---%
ci COMPLIANCE OR
COMMERCIAL CHANGE OF USE
MULTIFAMILY SIGN
LOT COVf&AG I UIR 1 9 - D .. SETBACKS_(Ff.$ P&W?D ETBACKS (Fr.)
ALLOWED PROPfjj&_ -fRONT SIDE REAA FROW3 MItD REAR
0
OR "'L�I%4TS
PARKING LOT AREA PLANNING REVIEWED BY DAT
REOD PROVIDED E
z
REPAIR
GRADING FENCE
CYDS ( X FT)
I
REMARKS
_12,4EMOLISH
—
TANK OTHER
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
(ME OF USE, BUSINESS OR ACTIV N:
CHECKED BY TYPE C OCCUPANT
t:2
NUMBER NUMBER OF
OF WELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
CRITICAL
AREAS
NUMBER
GROUP
]��V6 &X
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D
VALUATION
$
Description FEE Descriptlon FEE
Plan Check
State Surcharge
HEAT SOURCE
-
I
GLAZING %
LOT SLOPE %
Building Permit
—
City Surcharge
PLAN C
0.. —4-tr—
Plumbing
__ :U=
Mechanical
THIS PERMIT AUTHORCMS ONW THE WORK NOTED. THIS __
PF rfcnVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLV. ANY CONSTRUCTION ON THE PUBILIC
DOMAIN Grading
(CURBS, SIDEWALXS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERAirrAPPUCATION: ISO DAYS
L PERMIT UUM I YEAR - PROVIDED WORK 13 STARTED WITHIN 140 DAYS Engr. Inspection
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPILICANT, 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 CIAJMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORPECr, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit unfit sIgnod by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Officiall or hi0or Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEITS��ENSATION INSURANCE AND RCW 18.27.
01 LS SIG RE DATE
T
SI R R a DATE SIGNED
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111110
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771-0220
tELEAStI5 hY
ATTENT16N V
Off 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
a
30
Mn4pECTED OUTSTANDING ISS.UES - GRA,NT FINAL PROJEM APPROVAL.
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