20030498.pdfDATE
CITY OF EDMONDS -
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
Poe Reve
MAILING ADDRESS
-1-37,72 N6104-) L-Y^-e
CITY TELEPHONE
e4w"'4' --,-"Zip
NAME _ .
ADDRESS
2o-e,( �ve
CITY Zip TELEPHONE
024 -z(0.+4-j .2)5 z z
NAME J* ICBL# -
oww-
ADDRESS
CITY ZIP ITELEPHONE
STATE LICENSE NUMBER
CHECKED BY
PROPERTY TAX ACCOUNT PARCEL No.
6`04-&1,5—o0V_ 400e7_01
NEW
191 RESIDENTIAL
PLUMBING / MECH
MADDITION
[3 COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
0 MULTIFAMILY
0 SIGN
REPAIR
0 GRADING— CYDS
< !iu
FENCE X FT)
I — —
E] DEMOLISH
TANK
OTHER
[:] GARAGE
RETAJNING WALL
13ROCKERY
FIRE SPRINKLER
—CARPORT
FIREALARM
OWE OF USE HILSINESS
OR ACTIVrM EXPLAI
i;;A4V�
.1 (4
NUMBE
OF
NUMBER OF
WELLING
1
CRITICAL -7-�
AREAS
1 4/9
STORIES
UNITS
N U M B E R
DESCRIBE WORK TO BE DONE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMrr COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVMAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
I.—
PERMrrAPPUCATION: 160DAYS
LIMM I YEAR - PROVIDED WORK IS STARTED WTTHIIN 180 DAYS
SEE 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEFIE13Y 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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF T DIR OF THE STATE OF WASHINGTON RELATING TO
OMPEV10
OM
WORKMEWS C INS CE AND RCW 18.27.
DATE SIGNED
4. 2- 1)
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ( 11--_ I %--�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEViTIFI- OR:GINAL-FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PNK-OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
U, JPERMITEXPIRES -T-1 IILJ�_
USE
ZONE PERMIT
ks.- tz- NUMBER
J013 U TE/APT#
ADDRESS .111cz'
FW NAME/SUBDIVISION NO.
LOT NO.
ID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
--*,
AW Permit Required
Street Use Permit Raq'd
EXISTING PROPOSED
Inspectio" Required 13
Sidewalk Requited 13
REQUIRED DEDICATION— FT
Ur4ffWound
Wiring required
METER SIZE
LINE SIZE
NO. OF FjXTYRES
PRV EQUIRED
YE NO 13
z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
1130 0 MU) IAWEVICUS.24��
�MA tI2Vn I I
'673*0NAL
ENGINEERING REVIEWED BY
DAT
FIRE REVIEWED BY
DATE
rL
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
BOND
I
REO'D
[I
POSTED
I
13YEs 64M
s
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
Vol*
0
,
7— 5'
I 2_4
LOT COVERAGE
REQUIRED SETBACKS (Fr)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
to i10 le
10
3 -7 teA.
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REO,D PROVIDED
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REMARKS
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- lur'Le 41 Air
ISPECIAL INSPECTION JAREA I OCCUPANT
REQUIRED)d j4f�?� 4k,.k,- _ya LOAD
YES . , _C*
REMARKS
PROGRESS INSPECTIONS PER USC 1108/FINAL INSPECTION REG'D
VALUATION qAAyAkn"_
$'* zo- i
M_ mr,=_
Ak5j,,I& . Pv, * 7,03'r) '
Description
FEE
'Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Dcl(')
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
PlanChk.Deposit
W1
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
So C? 'rp
Recording Fee
CALL
FOR INSPECTION
1A
771-0220
EXT 1333
Receipt #
APPLICATION APPROVAL
This application Is not a permit until Signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt Is acknowledged In space provided.
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