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DATE RECEIVED
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USE PERMIT
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO. LOT NO.
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LID FEE S
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AW Parmill Required
Street Use Pe-ft Rsqd
CITY ZIP TELEPHONE
EXISTING - PROPOSED
inspection Required
Sidewalk Raquired 13
REQUIRED DEDICATION- FT
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Wiring required 13
NAME
METER SIZE LINE SIZE -1 NO. OF FIXTURES PRV REQUIRED
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REMARKS
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PROGRESS INSPECTIONS PER UBC 1108ifFINAL INSPECTION REG'O
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Description FEE
Plan Check
HEAT SOURCE
GLAZING %
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Building P ermit
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VEST)ED DATE
Plumbing
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THIS PERMIT AUTHORIZES ONLY THE WORK NI ED. s PiRurr IOVERS WORK TO
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Grading
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
Engr. Review
2
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PERUITAPPLICATION: 160DAYS
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PERMIT UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MOD117X WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE C ITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HERESY 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 TO 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 COMPENSATIOINVIAlfiVRANCE A�D RCW 18.27.
SIGNATURE (OWNER 0
DATE SI 4ED
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Description FEE
State Surcharge
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
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Waste G owner's Nome: Phone No:
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Name. AdCrO.15. W-C iWUEWone No.:
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RABANCO REGIONAL LANDFILL 1-800-927-5641
600 Roosevelt Grade Rd.
Roosevelt. W4, MS6
4. Responsible Loc& State or EPA Agency NoMF and Address:
P.eA"rCA
I 10 Union Street
Seattle, WA 98101
5. Description otWoste Materials. 6. Containers 7. 3 (7. d 3
'Dia-, lype M (yd
Asbesto's Containing
Special Haridling Instructions and AcIditio-601 Information:
L 'ELED
D01.1KE BAGGEC LAS
OPERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurateIV described
.'4 above by proper shipping name ana are classified. packed, morked and labeled, and ore in all respects In proper
conclItloh for transport lo� highway according to applicable ln*rr�tionoi and government ragulations.
Nionth Day Year
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Kianth Day Year
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Pr* /Typed Nome SQno ur
11. Transporter 2 Acknowledgment of Receipt of Materials DOV Year
PrInted/Typed Nome Signature Month
Rabanco Translef --7
2733 3rd Ave. S. Z"
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Wage Disposal RRLC
13. Authorized WaVe Disposal Site Owner or Opetotor: Certification of;ezaict of osbos,;os muteri0is ctuvemd byl-his monifest
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RECEIVED
C)3 PERMIT EXPIRES
USE PERMIT
oil
CITY OF EDMONDS
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
"
JOB
ADDREss I ot —i i Ir CAWC
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OWNER NAMEINAME busl
PLAT NAME/SUBDIVISION NO.
LOT NO. ,
0
LID NO.
MAILING ADDRESS
e9
UD FEE $
7ESCP
RW Per d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED__
street use Peffnit sq'd
LmpectionAtiquirod 1:3
Sidewalk Required
Underlimund
CITY ZIP
TELEPHONE
REQUIRED DEDICATION— FT
Wiring required
NAME
METER SIZE
LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
AA
YES13 NO 13
�DDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
U
CITY ZIP
TELEPHONE
NAME
CBLIA�,`
7-i
ENGINEERING REVIEWED BY
ki(/f It
DATE
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ADDRESS
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FI-RE RE%ftEJMW1NSPE=--0--j4 -R-BQUIRED DATE W
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CITY ii'PtITELEPHONE 0 SV.MT To.. 12 M MA lk11f%M Iz
am-1 " n 9%
VARIAN(?bOR ELINE OR ADB# I SPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY ftB MUST 0 POSTED
no UIN;R
go
SEPA R�,�I SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLEIV +ALLOWED PROPOSED
UM I I
We
00 VIM INS I _I an
A U-2, () - I WM
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NEW
RESIDENTIAL
C] PLUMBINGIMECH
LOT%b
ALLOWED PRO
PROPOSED SET13ACKS (rT)
filift CftVE REAR
ADDITION
[3 COMMERCIAL
COMPLIANCE OR
11 CHANGE OF USE
SEB Dt
OLITION
IN—
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MULTIFAMILY
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PAMIN
REQ`D
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nWF-M&1TS
REPAIR [j GRADING CYDS
FENCE
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REMARKS
DEMOLISH TANK
0
_
Ei OTHER
aGARAGE RETAININGWALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
I- , r - --
N
CHECKED BY
TYP=Z7N
cong.
oCCUPAW� tj,�7
GROUP
INUMBE
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPECTION
OCCUPANT
LOAD
STORIES
UNITS
NUMBER
REQUIRED [:) YES
DESCRIBE WORK!TO BE DONE
17711le M
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/01NAL INSPECTION REO'D
rT 1!
--K�x =I pass
$
Description
FEE
Description
FEE
I
Plan Check
state Surcharge
HEAT SOURCE LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO- VESTED DATE
4 1
Plumbing
Oil
Mechanical
THIS PERMIT AUTHORGMS ORLY THE WORIi NOTM THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE p)IOPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
2
3 DOMAIN (CUM, SIDIWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SLPARATE PERMISSION.
Engr. Review
PEINITAPPILICATION: 1100 DAYS
PERMIT LAMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
dERBACK OF PINK PERMIT FOFkUCR9 INFOflMA ON.=
'APPLICANT. ON 13EHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANV A
Y&
ARISING DIRECTLY OR INDIRE NL
'Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE,
FROM THE ISSUANCE Or THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
It
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
UCATIOYNPPROVAL-
L
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-
CALL
Is ap Ica pot a pill until signed by the
a ap a
�nlg
71w.'
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
a r puty: and " are paid, and
.. ;0;9-Ed garlInapacqf0rovil:14
I
WO=Et-rS COMPENSATION RANCE AND RCW 10.27.
OF sl AT.E,.,
SIGNATURE (OWNEI�91`11A DAT�SIQNED
IA05)
77' 1-0220 f
AdEASED Ift
ATTENTION EXT 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
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