20030537.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
WNER NAME E OF BUSINESS
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STATE LICENSE NUMBER EXPIRAT ON DATE
CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO
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NEW RESIDENTIAL PLUMBING MECH
COMPLIANCE OR
ADDITION COMMERCIAL 1:1 CHANGE OF USE
REMODEL MULTIFAMILY 1:1 SIGN
G I G FENCE
1:1 REPAIR CYDS 0 1 FT)
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DEMOLISH TANK OTHER
GARAGE RETAINING WALL o FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS PR ACTIVIM EXPLAIN:
NUMBER
OF
STORIES Al 4
NUMBER OF
DWELLING
U NITS
CRITICAVOr r E1_f0011f"*r
AREAS
NU R
MOE
DESCRIBE WORK TO BE DONE 4
03 1 1 PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUFTE/APTO
ADDRESS I I I - L
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCF Approved
RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
BY
FIRE REVIEWED BY
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
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BOND
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POSTED
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXPI
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
P ROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
DATE
PARKING
LOT AREA
PLANNING REVIEWED BY
REO'D I PROVIDE
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REMARKS
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CHECKED BY ITYP NSTRUCT CqP§ OCCUPANT
1 &171 GROUP
SPECIAL INSPECTION REA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG-D
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HEAT SOURCE GLAZING % LOT SLOPE %
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PLM CHECK NO: I VESTED DATE
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Doscription FEE Description FEE
Plan Check 1 �5_ State Surcharge
Building Permit City Surcharge
9D
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONW. ANY CONSTRUCTION ON THE PUBUC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
I--
Engr. Review
PERMrr APPLICATION: 180 DAYS
IL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, 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 N
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 C17Y ORDINANCE
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Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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Recording -ee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
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
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or histher Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknovviedged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 16.27.
OFFICIALS SIGNATURE DATE
81 TUR (OWNE , OROW4
7 7, �
DATEZONED
1A 51
7-1,S--o
771-0220
R DATE
ATTENTION
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-INSPE R
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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RE -INSPECTED OU.TSTANDjNG ISSUES GRANT FINAL PROJECT APPROVAL
Dat-
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D DATE RECEIVE9
ATE RECE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OYTER NAMEINAME OF BUSINESS
MAILING ADDSS'
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CITY ZIP TELEPHON
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NAME
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ADDRESS Or
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CITY "LEPHONE _7q,
NAME CBL#
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PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDiVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pamilt Raclukod
SUM Use Parmil Wd
EXISTING — PROPOSED
limpection Reqi*ed
Sidewalk Recluked
REQUIRED DEDICATION— FT
Undargmund
WIMCrequired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
REMARKS
RESPONSIBLE FOR EROSION
JFIRE
C IP ITELEPH
zi ON
REVIEWED BY
'DATE
VARIANCE OR CU SHORELINE ORADB# I INSPECTION BOND
STATE LICENSE NUMBER EXPIRATI
(714 DATE I CHECKED BY C3 REO'D POSTED
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AL .0 1 YES $
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PROPERTY TAX ACCOUNT PARCEL: NO.
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SEPA REVIEW SIGN AREA HEIGHT
APIETE EXEMPT ALLOWED PROPOSED ALLOWED ' PROPOSED
EXP A"n.,,,
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL [j muLnFAmiLy
REM !IW CYDS
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PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
1-1 SIGN
o FENCE
X FT)
LOT COVERAGE REdUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
--------- 10—
PARKING LOT AREA IPLANNING REVIEWED BY DAT
REOD I PROVIDED
REMARKS
DEMOLISH TANK
GARA13E Ej RETAINING WALL
CARPORT J1 ROCKERY
Ei OTHER
0 FIRE SPRINKLER
FIRE ALARM
re4
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WVE OF USE, BUSINESS OR ACTIV" E#PLAIN:
CHECKED BY
RUCTI914 co-W2." OCC . UPANT
GROUP
NUMBER NUMBER OF
OFr DWELLING
STO IES UNITS
CRITICA%-
AREAS
NUMBER
SPECIAL INSPECTION JAREA
REQUIRED [] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
4etr
R, §000 LAAI�
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!REMARKS
PROGRESS INSPECTIONS PER UBC 1 08/FINAL INSPECTION RECtO
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VALUMI IU14
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Description
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FEE Description FEE
Plan Check
State Surcharge
FAT SOURCE LAMG % LOT SLOPE %
H G
&W _T N I+
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORUES ONLY THE.WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY 9NM ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS,SIDIEWAIL MARQUEES, ETC.) WILL REQUIRE
St
,LR:=W 881 ON.
Engr. Review
PERMIT APPUCATION:* ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK 18 STAMM WTTHIN 180 DAYS
Engr. Inspection
SEE BACK OF LMIT FOR MORE INFORMATION
.P
PINK PF
'APM ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
I� I AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
D D , WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
E _0
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Arnt 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 #
I HEREBY ACK40WLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECr AND THAT I AM DIE OWNER, OR THE DULY AUTHORMED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a perntit until eigned by the
TIGN; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Officiall or hisftw Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged in space provided.
WORKMEN - COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
(OWNE OR, E' DATE SIGNED
;T?� � -3
A
(425)
-7 �F
771 -0220
_a7 _1__ _/
1
DATE
T_
ATTENTION
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORGINAL-FILE YELLON-4SP�ECT/01`1
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
P=-OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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