20030590.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMPAME OF SINESSd
MAILING ADDRESS
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NAME
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NAME CBLH
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STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
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NUMBER
JOB SUITE/APT#
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
REVIEWED BY
FIRE RrIEWED BY—
Obtain Electrical Permit
DATE
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SEPA REVIEW
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SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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ALLOWED
PROPOSED
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GROUP
NUMBER
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NUMBER OF
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OCCUPANT
STORIES
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NUMBER 14jA
REQUIRED
JAREK-_
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DESCRIBE WORK TO BE DONE
REMARKS I
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Perm I it
City Surcharge A5,
PLAN CHECK NO: VESTED DATE
Plumbing
--, '-7/1 --
/2-401 S/ i
Mechanical
_� -
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'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 #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapoinsp.
Total Amt. Due_
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HERESY 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
IN VIOLATION OF THE LABOR C F STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Olficial or his/her Deputy: and Fees are paid, and
receipt Is a-,knowladged In space provided.
,P"SATION RCW 18.27.
WORKME-NS'p
OF 1 T E DtTE
E
I
SIGNAT DATE SIGNED
(425)
1
I
2RE g
=E T- To
771-0220
RELEAS D BY JDATF/
ATTENTION 'y
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 - 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 RECEIV
DAT RECEIVED
[PERMIT EXPIRES
1JSE PERMIT
CITY OF EDMONDS ZONE NUMBER
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JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS k-)
OWNER NAM E OFILISINESS ha
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CITY ZIP TELEPHONE
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NAME
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ZIP ITELEPHONE
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP App"rfed
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St" Use Psmo PAWOd
EXISTING — PROPOSED
kopscmn ReqWed
Sktawslk RoWired
REQUIRED DEDICATION— FT
urxiff"rA
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METER SIZE
LINE SIZE -1
NO. OF FIXTURES
PAV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
NAME
CBL N
unheated space& UMC 815,
ENGINK&BINQ RWqFWED BY DATE
ADDRESS
FIRE REVIEWED BY
DATE
CITY
NE
ID
STATE LICENSE NUMBER
EXPIRATION DATE C4ECKED BY
Main
lFlectrical PeWt`@W� i POSTED
PROPERTY TAX ACCOUNT PARCEL NO.
U
S YO I rje; IGHT
CO L ONLA ALLOWED1 PROPOSED
QO 5-7d, 3co Aoo 00
1
gl.. I
EXP
NEW RESIDENTIAL
XPLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED BET13ACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
I
ADDITION COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
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9
REMODEL MULTIFAMILY__
SIGN
PARK
REO'D
1111101005 BV16 DATE
D YC INSPECTOR
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0 REPAIR
GRADING
CIDS
FENCE X
( _ _FT)
REMARKS
DAVITS SHALL NU
DEMOLISH
TANK
[3 OTHER
BE ACCEPTED
oGARAGE
CARPORT
[:3 RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR :�:
CHECKED BY
—11�
cot% OCCUPANT
ITYMMON
I W— GROUP
NUM ER
olf'!
NUMBER OF
OWELLIN
CRITICAL
AREAS
SPECIAL INSPECTION
—
OCCUPANT
sToilEs
UNITS
NUMBER
REQUIRED [] YES
JAREA
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION RE(WD
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
City Surcharge
1
1 --)
PLAN CHECK NO:
M2
Mechanical
zj / ).
THIS PERMIT AUTHORIZE8 ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
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 APPLICATION: IISODAYS
PERMIT ILIMM I YEAR - PROVIDED WORK 18 STAKED WITHIN 160 DAYS
Engir. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIC". 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 C17Y OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATiON
APPMATION
APPROVAL
GIVEN 19 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
iN VIOLATION OF THE LABOR CPPWE STATE OF WASHINGTON RELATING TO
"I
FOR INSPECTION
Building OMcW or hlslhw Deputy: and Fee# are paid, and
receipt Is ackrinw1odged In space provided.
WORKMENS�SATIQNI RCW 18.27.
�N*
OF I TE
SIGNATURE W=WVME&A6J(6Er0'
DATE SIGNED
(4425)
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X
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71
7 -0220
ME
RELEASED BY JDAItif
Y f
ATTENTION Off 1 3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
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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