20030600.pdfI
DATE RECEIVED
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PERMIT EXPIRES A/zo—Y
CITY OF EDMONDS
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ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
SUITEIAPT
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15
OWNER NAMEnIAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
MAILING ADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Ap 'o"d
RW ParmitpRatt."Od
street Use Permit Req,
CITY ZIP TELEPHONE
EXISTING — PROPOSED
inspection R*qui(ed Ell
Sidewalk Required 13
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REQUIRED DEDICATION— FT
Underiyound
Wiring requited 11
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NAME
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED 0
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YES 13 NO C3 3
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CITY MT.ELE7NE
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NAME
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ENGINEERING REVIEWED BY
DATE
ADDRESS
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
ACCOUNT PARCEL NO.
[:] NEW
RESIDENTIAL
0 ADDITION
COMMERCIAL
REMqDEL
�*P<Mui.TIFAMILY
GRADING
0"REPAIR
CYDS
DEMOLISH
0 TANK
GARAGE
CARPORT
o RETAININGWALL
ROCKERY
UWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
N UMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
DATE
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
IFENCE
3 ( _ X_FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
FIRE REVIEWED BY DATE LU
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VARIANCE OR CLI
SHORELINE OR ADB#
1V0,7-pF&,b
INSPECTION
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113YES XNO
BOND
POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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11
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LOT COVERAGE
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FO
ALLOWED PROPOSED
FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
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CHECKED BY ITYPE OF CONSTRUCTION I CODE OCCUPANT
CRITICAL A-13—r- GROUP 2
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER 104 REQUIRED [3 YE LOAD
REMARKS 2
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUA11ON
Description FEE Description FEE
PI an Check State Surcharge 1/460
HEAT SO4RCE GLAZING % LOT SLOPE % Building Permit City Surcharge
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PLAN CH5F1 NO! VESTED DATE Plumbing
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Mechanical
THIS PERMIT AJUTHORIZES ONLY THE W6RK NOTED. THIS PERMIT COVERS WORK TO
BC DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMITAPPLICATION: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. Deposit
'APPILICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review
'R S
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IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
TL
Y
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
HE
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT HE
Landscapelnsp.
Total Amt. Duo
NCE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ON
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIO N.,
-
Recording Fee
Receipt #
'TION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPMATION AP L
IT OF
GIVEN IS CORRECT', AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
RUC.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
:)YED
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
a To
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
OFFLCJALqj SIGNATURE DATE
FF q
DATE SIGNED
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6-7-0-?
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771-0220
IRELBY
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L DATE
XTTENTION
M 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING