20030563.pdfa
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP
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NAME
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STATE LICENSE NUMBER
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EXPIRjf1TION DATE
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RESIDENTIAL
PLUMBING MECH
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COMPLIANCE OR
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REMODEL
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SIGN
[3 REPAIR
0 GRADING CYDS FENCE
( — X—FT)
DEMOUSH
13 TANK
OTHER
oGARAGE
CARPORT
[:] RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
UWE OF USE, BUSINESS OR ACjIVrDWWLAIN:
NUMBER DUMBER OF CRITICAL
OF WELLING AREAS
N
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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111TfUIRCE GLAZING % LOT SLOPE %
CHECK NO: VESTED DATE
THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALIKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160DAYS
PERMIT LIMIT! 1 YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAJAAGES 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 REOUIREMEII OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYB ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOFt CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATOrOftRANCE AND RCW 18.27.
SIGNED
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17, N7
PERMIT EXPIRES 17V
ZONE PERMIT
NUMBER
JOB SUITEIAPT*
ADDRESS
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PLAT NAME/SUBDIVISION NO. LID NO.
—LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Suest Use Priffnit Raq'd
EXISTING — PROPOSED InspectlonfloquIred
Sidewalk Required
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REMARKS
PROGRESS INSPECTIONS PER UBC 168/FINAL INSPECTION RE0`0
VALUATION
Description
FEE
Description
FEE
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Building Permit
City Surcharge
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Plumbing
Mechanical
Grading
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Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged in space provided.
QLFFICIA�S SIG ATURE DATE
1 7, s. 7, 7/;;
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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. INSPECTOR
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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DATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATIONJ7 JOB SUITE/APIP
ADDRESS
IS-11 -7 PL
OWNER NAMEINAME OF BUSINESS
— PLAT NAME/SUBDIVISION NO -TT No. LID NO.
711-9 1/0/,� LO
M&LING ADDRESS LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Per" Required
J�% Street UeA Parmh Req'd
EXISTING — PROPOSED Wipecdon Required
_qITy ZIP TELI PHONE
Sidewallk Required
UndarwowW
7W 97,.5-��-775 REQUIRED DEDICATION— FT vvmg requirea
IM I T-70 13
NAME METER SIZE 0. OF FIXTURES PRV REQUIRED
YES C3 NO C3
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ELEPHONE
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NAME CBL# 5 1 E7
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ZIP ONE
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STATE LICENSE NUMBER EXPIR111TION DATE By REaD POSTED
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NEW RESIDENTIAL PLUMBIN61 MECH
ADDITION COMMERCIAL COMPUAIiCE OR I mw (%.Ma� IFODC (c
CHANGE OF USE 19,30.020 (c
PAIKIN PLAMNLW2j"
Cl REN40DEL 1:1 MULTIFAMILY SIGN REQ`D
REPAIR GRADING FENCE
CYDS FI) REMARKS
Q DEMOLISH TANK OTHER
GARAGE' o RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR A
OCCUPANT
CHECKED BY TYPE T
i!p M� GROUP
CMNUMBER OF CRITICAL I
OF 3 AREAS SPECIAL INSPECTION JAREA OCCUPANT
STORIES NUMBER REQUIRED LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REaD
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ZaLa&6� VALUATION MF%FNVIA Inks I jobf
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Description FEE Description FEE
Plan Check State Surcharge
JEATrRCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
a I I
Plumbing
A CHECK NO: VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPESITY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DONIAIN (CURN, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
t: BEPMATEPEPJAISSE.
r. Review
P ER M IT AP PL I CAYI & �J DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK 15 STARTE]D WITHIN 180 DAYS Engr. Inspection
SEE B=K OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review*r 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 #
I ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, 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
'i NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HEREBY 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 unW signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/bor Deputy: and Fees are paid, and
IN VIOLATION OF THE LABORSOQE OF THE STATE OF WAGHINGTON RELATING TO FOR INSPECTION recolpt Is acknoydedged In space provided.
WORKMENS COMPE IS�SV�,ANCE AND RCW 18.27. DATE
SIGNED (425) QFFICtAW SIGOATURE
slaKYURE % -_ �/,/ a�_ I
"0 1 1 ) 7
771 -0220 FIELEA VATE
ee�l 1,7, S
ATTENTION EXT 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. INSPECT70.R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTIOW10iii PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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