20030539.pdfa
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY ZIP
NAME
ADDRESS
PERMIT EXPIRES
USE I PERMIT
ZONE EYA�IJMBER
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
D NO.
'to
FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Requited
Street Use Permh Rsq'd
EXISTING — PROPOSED
inspection Required
SidinvalkRequired
REQUIRED DEDICATION- FT -
Undetwound
Wiring foquinsd
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
t
[
I YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY
ZIP
TELEPHONE
NAM
CBL N
1 ""gr'k VeA-ara_enn
ENGINEERING REVIEWED BY DATE
E
FIRE REVIEWEND BY DATE
us
01
zlil TELEPHONE
Ir
I
)ATE HECKED BY
HORELINEO ADBN J:INSPECTION BOND
REO'D POSTED
VARIANCE -OR CU R 1$
S LidEkSE'NUMBE.
OYES 13NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PRO POSED
PROPERTY TAX ACCOUNT
PARCEL NO.
EXP ,
NEW
RESIDENTIAL
PLUMBING MECH
LOT COVERAGE REQUIRED SET13ACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DA7
0.
REMODEL
MULTIFAMILY
SIGN
REO'D PROVIDED
REPAIR
GRADING CYDS
FENCE
FT)
REMARKS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
o F RE SPRINKLER
FIREALARM
OWE OF USE, BUSIN
OR ACTIVITY) EXPLAIN'
CHECKED BY TYPE OF CONS E OCCUPANT
X�
GROUPP
I x
C
NUMBER
NUMBER OF
DWELLING
I
—r—CRtTICAL
AREAS
V
TInN AREA OCCUPANT
LOAD
OF
STORIES C,7 _
UNITS
I NUMBER /
REQUIRED YE I S
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IrIFINAL INSPECTION IRE
I Remodel - Al I new n)DIJi AM, I _3
� i A /,I.,e sp;
1.116M MR
L6 A. I.A e ii &nve, -k
Akw
VALUAnON
ALL
V
P 1A/1'
$ <-D, 000
0:�,_.Pv/etr scriptlon I
FEE
DescriptIon
FEE
aA 102 ed
-[an Check
State Surcharge
q_L60
I
E %
H SOURCE% GLAZING % LOTSUOPE %
Building Per
ui
City Surcharge L
PLAN CHECkNO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERM� CdVERS WORK TO
ON THE PUBLIC
t:
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION
Qad�A.4;6
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
'2
IL
PERMIT APPLICATION: 180 DAYS
PERMIT Llmrp 1 YEAR - PROVIDED WORK IS STARTED WITHIN 11110 DAYS
Engr. Inspection
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
I
I
-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 MOM ANY AND
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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
TotalAmt.Due ,
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
ML41 1,
I HEREBY ACANOWLEDGE 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 Im not a permit until signed by the
Building Official or hisftr Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR ONSPECTION receipt Is acknowledged In space provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
OFFIGI&Li-SIONATURE DATE
GNAT
UR WNEII R AGENT) DAT SIGNED
1-425)
'1 0-7
ATTEN ION
771-0220
M 1333
D A5ATE
4A
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 - INSPJ(CTOR
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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.91
ITY OF EDMONDS
f% A
GARY HAAKENSON
MAYOR
We are in receipt of the check for $2,163.00 to pay for the, attached building permits.
to call for a building
your receipt is enclosed. Please be advised that you still need
&
aw-*;ewn ThenermitsareonlygnodforMdays. Please call as soon as voss' leto
ection. hot line is 425-771-0220
required inspection. e' in g msp
schedulethe
extension 1333.
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01
Jeannine Graf
B ldiniz
Official
ui
. ..........
Attachments
S teven Bohrer
Cc:
Incorporated August 11, 1890