20030556.pdf13
DATE RECEIVED,�L
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1 PERMIT EXPIRES
CITY OF EDMONDS
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USE PERMIT
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NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
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OWNER NAMFINAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MA LING ADDRESS
LID FEE $
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TESCP Apprcyv@d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
0
CITY ZIP TELEPHONE
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EXISTING. Street Uta Permit Roq':T
'PROPOSED inspec-don Required
Sidewalk Required
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REQUIRED DEDICATION— Fr UnderWound
- winno req ad 13
NAME
METER SIZE LINE SIZE NO. OF FIXTURE PRV REQUIRED
YES13 NO 13
ADDRESS
REMARKS
1
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE ____1 %bi V.) - ty - vv_�, t-W-4-V % W-4-i "- iv %I " I M %A V& Lj t-=, 1 n
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NAME CBL #
ENGINEERING REVIEWED BY DATE
ADDRESS
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7po. 6o,47795677
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE IIEC
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VARIANCE OR cu SHORELINEORADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE REQ'D POSTE
WYES ONO $6��P,454Q
A? -1 15 -7 " F$,.�
64 SEPA REVIEW SIGN _AREA - N HEIGHT
7 OSED ALLOWED , PRIPOS7
ACCO PjkRCEL NO. EX ALLOWED
PR PERTY TAX PROP
EXP
C KED LOT COVERAGE REQUIAED SETBACKS F) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL El PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMPLIANCE OR
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ADDITION COMMERCIAL CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED 13Y DATE
REMODEL MULTIFAMILY SIGN REOD I PROVID D
0
REPAIR GRADING FENCE X
CYDS FT) REMARKS
DEMOLISH 0 TANK o OTHER
1 GARAGE -1 RETAININGWALL FIRE SPRINKLER
:1 CARPORT 0 ROCKERY FIRE ALARM
(TYPE OF UA BUSINESS OR ACTIVTM EXPLAIN: JT 0 CON R
CHECKED BY YPE 'ION co
A OCCUPANT
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NUMBER NUMBER OF I t\ 1 XT
0 OF DWELLING SPECIAL INSPECTION AREA OCCUPANT
STORIES UNITS REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG
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$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE T GLJONG % LOT SLOPE % Building Permit City Surpharge
PLAN CH22 _16 VESTED DATEfi P Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERI(Fr COVEAS WORK TO
t: BE DONE ON PRIVATE PROPER1`Y ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
D0M.1UN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160DAYS
916 PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
7— Fire Review Plan Chk. Deposit
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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 PERMrT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due xv
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee
I HERE13Y 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- 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 hisfher 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.
WOR N'S COMPENSATI RANCE AND RCW 18.27.
ON04VII OFF.WIALS SIGNATURE DATE
III RE (0 ER AGE DATES NED 1425)
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771 -0,22.0 'RELEASE- BY PAT
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL W/7'Ot
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- (;R11- INAL. YE
ILE �YCVV-141ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PIN - FrR GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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MEMO TO:
. FINAL PROJECT APPROVAL FORM
PERMIT COORDINATOR, BUILDING DIVISION
TO:
DATE:
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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