20030617.pdfa
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
-7 -70 8" [?,1- 111-11.t 61-re& S Ld
CITY ZIP I TELEPHONE
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NAME
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ADDRESS
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CITY ZIP ITELEPHONE
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NAME 1CBL#_ - -
ADDRESS %#
700ef
17S_ istr412-4PE:�-
1563
CITY
ZIP
I TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
CHWAQkBY
_A_
6 42
PROPERTY TA* 'ACbOURT
PARCEL NO.
0 o's-s- 91 17 0 0 0 0
NEW
)S(RESIDENTIAL
PLUMBING/MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
I�CHANGE OF USE
XREMODEL
MULnFAMILY
1:1 SIGN
0 REPAIR
GRADING CYDS FENCE X FT)
DEMOLISH
TANK
OTHER
oGARAGE
CARPORT
RETAINING WALL 0 FIRE SPRINKLER
13 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVrM EXPLAIN:
clsftme_ra�dpA
heolne, acr.-
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
UNITS
NUMBER
-STORIES
DESCRIBE WORK TO BE'DONEWMIA "__Dtff?d164i0_-
CwtU JAPO
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PERMIT EXPIRES
UT_ ERMIT
ZONE
e&.�, Y PIUIMB&44��J - �617
JOB s,UITE/APT#
ADDRESS :222,K_ IqLj�
PLAT NAME/SUBDIVISION NO. LOT NO. L D No.
L:D FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP MY Permit Requ:rod
Street Use Perm t Roqd
EXISTING - PROPOSED Inspection Required
Sidewatic Required
REQUIRED DEDICATION- FT UnderWwd
Wiringrequired
METER SIZE LINE SIZE I NO. OF FIXTURES PR EQUIRED
YESW NO 113
&
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
BY DATE
FIRE REVIEWED BY DATE I lurr"
VARIANCE OR CU
SHORELINEORADB#
I INSPECTION
BOND
POSTED
1$
__iREqD,*
0YES *0
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE
ALLOWED PROPOSED
ALLOW D
ED PROP
I VXEMP,
-XPkj
��p
r.40
LOT COVERAGEU
REQUIRED SETBAC4)FT.)
PROPOSED SETBACke (FT)
ALLOWED PROPOSED
K100
FRONT SIDE
t,6 CVV*,
REAR
I; e
FRONT URSIDE REAR
t40 Q-k� <1 -9- z
PARKING
4��D I PVVIDED
L4 IT AREA I PLANNING 9'EVIEWED BY DATf_'
_'4n 0 PA
EER
j 2sf:.
CHECKED ;Y TYPE 0KCONSTRUCjION C E OCCUPAV,
GROUP/<
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE
. 40ittigr VALUATION
4ACA
irm", 6i,%k-. hand StIlt d� A
im Description FEE Description FEE
Plan Check [State Surcharge 5D
HEA9 SOURC�,. GLAZING % LOT SLOPE % Building Permit City Surcharge
1&� I Z�_6
PLAN CHECK NO: VESTED DATE Plumbing 1_0 hl Ryb-
Mechanical
THIS PERMIT AUTHORCMS ONLY 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: ISO DAYS
PERMIT LIMM 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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Plan Chk. Deposit
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 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
4�1&
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENrORCE 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 histher Deputy: and Foes are paid, and
IN VioLATIOWOFTHE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN' LCOMftVSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
BIG ATUR (OWNERJOR AGENT]I
DATE SIGNED
(425)
j 7�
17-2f - 4'�,l
771-0220
E BY 16Afri
ATTENTION
Off 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-
- 1
ORIGINAL - FILE YELLOW -WPFCTAR
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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