20030551.pdf11
DATE RECEIVED I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAMrz OF BUSINESS
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
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_e96 5-
SUITE/APT4
1�i CNN & k("'A X Oxss(�!I -c,
PLAT NAME/SUBDIVISION NO.
LOT NO. LID NO.
MAILING ADDRESS
LID FEES
an
7ESOP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permn Requited
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CITY ZIP TELEPAONE
EXISTING — PROPOSED
Street Use Parmlit Req'd
Inspection Required
Sidewalk Required
jaktCv� 9to-2Z
REQUIRED DEDICATION—
FT UnderWound
Wiring required 13
NAME
METER SIZE LINE SIZE
NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY, zip, ONE
TELEPH
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NAME jCBL N
ENGINEERING REVIEWED BY
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ADDRESS
FIRE REVIEWED BY
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CITY ZIP TELEPH E
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771- 7W?;16,,9
VARIANCE 9R CU SHORELINE OR ADBI INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE 1,---CHECKED RE(kDjj POSTED
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MID
SEPAtREVIEW 9IGN
AREA HEIGHT
PROPEi�_Y TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
21!s�k QQ1 nu-1 c)Q ,
EXP
NEW RESIDENTIAL PLUMBING / MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
UR SIDE REAR
ALLOWED PROPOSED FRONT
SIDE REAR FRONT
COMPLIANCE OR
ADDITION COMMERCIAL
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07
CHANGE OF USE
0 REMODEL MULTIFAMILY SIGN
PARKING L AREA
REO'D
PLMANEWED By DATE
�IgROVIDED
GRADING o FENCE
REPAIR CYDS Fn
REMARKS
DEMOLISH 0 TANK ftA
IN
EGARAGE -1 RETAINING WALL F RE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OtAP%T7rTY) EX
CHECKED BY OCCUPANT
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NUMBER NU ER OF CRITICAL
%.-
OF DWELLING AREAS
STORIES I NUMBER
SPECIAL INSPECTION AREA
OCCUPANT
LOAD
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REQUIRED [] YES
DqV4BE WORI�TO BE C�o E
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
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VALUATION
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$ 1
Description
FEE
Description
FEE
Plan Check
S late Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge CD -
PLAN CHECK NO C2 �LQ2�j VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
* BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
* OhWN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMFTAPPIJICATION: ISODAYS
IL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
E-13gr Imiripacilie
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit 4-15
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY ORTIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt#
I 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 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'S COMPENSA��URANCE AND RCW 18.27.
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SIGjUjjPE4OW ER (R AGENT)) DATE SIGNED
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771-0220
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SED BY DATE
ENI . ION
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-
ORIGINAL - FILE YELL&V - INS40R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
INEE
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