20030452.pdf; DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSIN
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
7 AUUM55 I-
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CITY E
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STATE LICENSE NUMBER EXPIRATIqV_0A*1!
PROPERTY TAX ACCOUNT, PARCEL NO.
QQ s —/1 0 14 00
NEW ESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
oGARAGE RETAINING WALL
CARPORT 0 ROCKERY
GYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
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JOB
ADDRESS q3qjqL) 44L(nihert4m
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW P.1m1tR*.'1V"W
Street Use Permit Rsq'd
EXISTING — PROPOSED
Inspection Required
Sidewatk Required
REQUIRED DEDICATION— FT
Underground
Wiring required 13
MErER SIZE LINE SIZE OF FIXTURES
PRV REQUIRED
PO.
YESO NO
REMARKS
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OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
`01 ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
RE
1-6
1)70 1
U0INSPECTION BOND I
0 PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X_ FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
VARIANCE OR Cu SHORGLINC REO'D I POSTED
10YES 13NO $
SEPA REVIEW SIGN AREA, HEIGHT
COMPLETE - EXEMPT ALLOWED . PROPOSED I ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SET13ACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA EWED BY DATE
REO'D I PROVIDED I
A
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CHECKED BY
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AREAS
AREA
A
SPECIAL INSPECTION REA
NUMBER
_T, -
MPROGRESS
REQUIRED [] YES
REMARKS
INSPECTIONS PER U13C
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GROUP
OCCUPANT
LOAD
INSPECTION REO'D
$ - I -
Description FEE Description FEE
t'O]n
rge
Plan Check State SurEcharge
HEAT SOUR7E7 GLAZING % LOT SLOPE % Building Permit 30 City Surcharge
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PLAN CHECK NO: VESTED DATE ewp�bn hi
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURaS, SIDEWAILKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
PERMIT APPILICATION: IBODAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Inspection
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 HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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
FOR INSPECTION
WORKMEN'S 9OWENSATION INSURANCE AND RCW 18.27.
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SIGOATUR WNF1 OR AGE
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771-0220
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EXT 1333
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This appiic4sAls not a permit until signed by the
gr cVor IsIhor Deputy: and Fees are paid, and
I gW aclnowledgod In space pr-Ided.
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IT IS UNLAWFUL TO L SE OR OCCUPY j�_BRLIILDING 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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REANSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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