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USE PERMIT
CITY OF EDMONDS ZONE iiUMBER VZ;�2�1197_
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAME _g Jf I
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MAILING ADDRESS
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ADDRESS
CITY ZIP
NAME
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S8100
CITY TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERTYTAX AWICIIIEL�qo,
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NEW 0 RESIDENTIAL PLUMBING/ MECH
0 ADDITION COMMERCIAL COMPLIANCE OR
13 CHANGE OF USE
1:1 REMODEL E] muLnFAMILY SIGN
REPAIR [3 GRADING [3 FENCE
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1:1 DEMOLISH [3 TANK ci OTHER
GARAGE RETAINING WALL 0 FIRE SPRINKLER
CARPORT Q:R;&15RY FIPEALARM
("E OF USE, BUSINESS 60a:k�
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS J 01 NUMBER
DESCRIBE WORK TO BE DONE
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW ParniAt Required
EXISTING - PROPOSED
Street Use Permll Raqd
inspection Required
Sidewalk Required
REQUIRED DEDICATION-,- FT
UndwWMM
Wiring required
METER SIZE
LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
YEsI3 NO 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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DATE
BE ACCEPTED
FIRE REVIEWED BY DATE 11111
VARIANCE OR CU SHORELINE ORADB11 I INSPECTION I BOND
REQ'D POSTED
13YES 13NO s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED ROPOSED AL LOWED , PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (FnT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
&EoILARWe VINKSM BY DA E
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REQ` PRO E I
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REMARKS 21
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PROGRESSI NSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'D
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Description FEE
Description FEE
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Plan Check
State Surcharge
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HEAT5.OUFICE LAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It 1E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
15 PFRMITAPPUCATION: ISO DAYS
UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IIN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
Receipt #
9:
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
�
AP CATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CrTY AND STATE LAWS REGULATING CONSTRUC-
CALL
. p
Is ppil flonis note permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Bu
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M I or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
r I Is acknowledged In �7co provided.
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WORKMEN'S COMPEN!�3��CE AND RCW 16.27.
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S1qq4RE DA
SIG DATE SIGNED
(qftlR O�AGEPM
1495)
'MATURE
771-0220
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11.01SCO
0 By DATE
WT-tENTION
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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(.rDATE RECEIVED
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PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER Z"00;90 y
JOB SUIMAPT#
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CONSTRUCTION PERMIT APPLICATION ADDRESS M4�ylv
OWNER NAMEMME OF BUSINIES4
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MAILING ADDRESS
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CITY Zip I TELEPHONE
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NAME
ADDRESS
CITY ZIP
NAME CSL
Wesce:7 I
ADDRESS
S900 1,,�OY77 oll"VIC,167
CITY ZIP ELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERTY Tj%X A U PARCEL NO.
j C) C) q _ qq
NEW RESIDENTIAL [N PLLIMBINGIMECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
0 REMODEL 0 MULTIFAMILY SIGN
REPAIR GRADING FENCE X
CYDS FTJ
DEMOLISH [3 TANK 0 OTHER
o GARAGE RETAINING WALL FIRE SPRINKLER
r
CARPORT QJOCKERY FIPE ALARM
EXPLA
(TYP E OF USE.BU SINESS �i= IN:
NUMBER I NUMBER OF CRITICAL
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE5CP Ap=
RW P@ffrA ad
Street Use Peffnit Raqd
EXISTING — PROPOSED
Inspeedwfigquired
SIdews* Required
REQUIRED DEDICATION—
FT
undsr�
Witingfequired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
REMARKS
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TAni M91AINACIF
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Type B or L
vent connectors
requiffl on fuel
-burning appliances In
FIRE REVIEWED BY DATE cc
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VARIANCE OR CU
SHORELINE OR ADB#
10YEs
INSPECTION
REO'D '
BOND
POSTED
13NO
S
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED POSED
PR7.
EXP
,
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
F RONT L/RSIDE REAR
PARKING RF11131 REVIEWED BY DATE
RECID PROVIDED 06
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REM,A
NOT
CHECKED BY
(Rq=ON'
ITYPMrS
OCCUPANT
GROUP
OF DWELLING AREAS SPECIAL INSPECTION JAREA
STORIES I UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC
I
'I -&Le 16f+1w1i
HEATj3OUaCE
PLAN CHECK NO:
THIS PERMIT AUTHOMIUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPEM ONLZ ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
BEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CffY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
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 TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT113N OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSA��CE AND RCW 18.27.
01�.PO,R AGENT)
DATE SIGNED
i - -�, o3
VALUATION
$ /�)D() Cz
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
IA&3r-%
t"T"I
771-0220
EXT 1333
LOAD
INSPECTION RECrD
Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt #
Total Amt. Due Ts
Receipt # j�aI742
CATION APPROVAL
ot a permit until signed by the
M,h,Iw,b,*er Deputy: aqo ftes are paid, and
Is acknow 96pice provided.
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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