20030541.pdfDATE RECEIVED PERMIT EXPIRES
SE PERMIT
CITY OF EDMONDS ZONE NUMBERZ&_-�� '01) q
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNER NAMEINAME OF BUSINESS ADDRESS ZZ
KAU- PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
MAILING ADDRESS LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW .
T-�_q - T) Z_ &� Street Use Permit Rect'd
CITY ZIP EXISTING — PROPOSED Inspection Required
j TELEPHONE Slde*alk Required 13
REQUIRED DEDICATION— FT Undergraind
a-a-t-:21242 �Z/ Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
YES 13 NO 13 z
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ONE S PQ.-n c)k PjV 10 0
NAME CBL
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DATE
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FIRE REVIEWED BY DATE
CITY 71P TELEPHONE Imt
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
R E QD, POSTED
43YES,45INO is — - -_
BEIRA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED. ALLOWED I PROPOSED
s-A o 0 000 '600 1 1
EXP C�5
PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.). PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL 0 ALLOWED PROfOSEO� FRONT SIDE REAR FRONT UR SIDE IREAR
0 0 z
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n"�DDITION COMMERCIAL -.I—
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REMODEL MULnFAMILY SIGN RE 'D I P
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0 REPAIR CYDS X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAININGWALL F RE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF USE USINESS OR ACTINTM EXPLAIN:
CHECK!ED 7BYTYPE 05&qNWUCTION jCOQE OCCUPANT
GROUP
NUMBER NUMBER OF CRITICAL 7:UV & f R '�;
OF DWE NG AREAS SPECIAL INSPECTION JAREA OCCUPANT
ST RIES Al
I NUMBER U.,e REG' "RED 0 YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
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A 0'6- g0j LA I VALUATION
Des�rlptlon FEE Description FEE
State Surcharge
Plan Check 6
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HEAT SOURCE OT LOPE%
Gkd Building Permit City Surcharge
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PLAN CHECK NO: VESTED DATE Plumbing
Q-3.- Z2 ' Z Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t__ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPUCATION: 160 DAYS
PERMIT UMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Y22
'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
a EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM 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. Total Amt. Due
0
,I NOR LIMIT IN ANY WAY THE CrrY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foos 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'S39UBE SATION INSURANCOND RCW 18.27.
OFFICIALS _51G NATURE DATE
SIGNATUR (OWNERO AGE DATE SIPNED 1425)
7A h�S
771-0220 �
REL 'D4/E
7
Off 13
33
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 Y"ELLOW - INSPICTOR/
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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