20030638.pdfDATE RECEIVED
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USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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CITY ZIP ITELEPHONE
NAME
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CITY
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TELEPHONE
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STATE LICENSE NUMBER
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EXPIRATION DATE
VY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
0 REMODEL
muLnFAmiLy
SIGN
REPAIR
GRADING
CYDS
FENCE
( _:jj X 194tP FT)
DEMOLISH
TANK
OTHER
[3 GARAGE
CARPORT
ci RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPIE OF USE, BUSINE88 OR ACTIVIM EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF WELLIN AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO dE DONE
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HEAT SOURCE GLAONG % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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THIS PERIAIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
OF DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERUTTAPPLICATION: 100DAYS
PERMIT LIMIT! 1 YEAR - PROVIDED WORK IS 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 DAMAGES 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 REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CnYS 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
wnw(uEN'SAGG-PINISATION INSURANCE AND RCW 18.27.
ED
DATEjIGN,/
PERMIT EXPIRES
monam�
PERMIT
NUMBER C�W_172
SUrrE/A"#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP ApPtOv9d
AW Permit Required
Street Use Permit RWd
EXISTING — PROPOSED
InspecWn Required 13
Sidewalk Required 13
REQUIRED DEDICATION— Fr
Undergmuund
Wiringreq 1r*d [3
METER SIZE
LINE SI E
NO. OF FIXTURES
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REMARKS
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VARIANCE OR CUI SHORELINE OR ADB# INSPECTION BOND
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13YEs 13NO
SEPA REVIEW SIGN AREA HEIGHT
COMMIC . EXEMPT ALLOWED ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D PROVIDED
REMARKS
CHECKED BY ITYPE 8 N OCCUPANT
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INSPECTIONS PER UBC 1108/FINAL INSPECTION REG-0 9
1 01
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fga—
CALL
FEE Description
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit 61 It)
Receipt #
Total Amt. Due
11 Receipt #
APPLICATION APPROVAL
This appil i's not a permit until signed by the
ding Offil 1.1h.r Deputy: and Fees are paid, and
I r a c a ?t I,.. Inowledged In space prov4d.
kSED BY
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE � IL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
(425)
771-0220
FINAL PRO.YPVT APPROVAL FORM
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USE PERMIT
ZONE NUMBER -i<7
CONSTRUCTION PERMIT APPLICATION
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JOB SUITEIAPTO
ADDRESS
OWNER NAME/NAME OF BUSINESS
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PLAT NAME/SUBDIVISICIN NO. NO. LID NO.
MAILING ADDRESS
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CITY TELEP
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Street Use Pim" Pao
EXISTING — PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION— Undargrwid
FT
Wring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURE
P RV REQUIRED
I
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I YES 13 NO C3
ADDRESS REMARKS
OWNERICONTRACTOR
RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
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NAME
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ENGINEERING REVIEWED BY DATE
ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINEORADB# INSPECTION BOND
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REO'D POSTED
I 13YEs ONO $
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
7M
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EXP
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1:3 NEW RESIDENTIAL 11 PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
—4
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COMPLIANCE OR
ALLOWED PROPOSED FRONT SIDE REAR FRONT. L/R SIDE REAR
COMMERCIAL
ADDITION 1:1 CHANGE OF USE
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PARKING
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LOT AREA PLANNING REVIEWED BY DATE
RECID PROW
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[3 GRADING FENCE
REPAIR CYDS x Fr)
REMARKS
OTHER
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0 DEMOLISH [3 TANK 0
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CARPORT ROCKERY FIREALARM
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ITI ITI
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CHECKED BY TYPEr 0 ST
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NUMBER NUMBER OF L V./
CRITICAL
OF DWELLING AREAS
STORIES UNITS JMBER W
1
SPECIAL INSPECTION OCCUPANT
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JAREA
REQUIRED [] YES LOAD
DESCRI )NE
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REMARKS
PROGRESS INSPECTIONS
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PER USC 108/FINAL INSPECTION REaD
667D Ex F&-ijce
VALUATION
Description FEE Descirilpflon FEE
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Plan Check
State Surcharge
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HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
Surcharge
PLAN CHECK NO:
�2L VESTED DATE
Plumbing
THIR PERMIT AUTHOREMS ONW THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
1= BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
t: SEPMATEMMISSION. .
Engr.-Review
PERMITAPPLICATIOW. IGO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 19 SIARTED WrTHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND 'U'CE30R'
Fire..Review Plan Chk. Deposit
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
OS,WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
CLAIMS ?R*DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection Receipt #
6U
FROM THE I 6LIANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp. Total AITIL Due
N,
OR LIMIT IN ANY WAYTHE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
_e
Recording Fee— Receipt #
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN 18 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-
i Is not a permit until signed by the
CALL This &WICI&I
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WId no ON d,and
Of /her Deputy: and Fees are pal
FOR INSP rmqtis owledged In space provi
ECTIO14 t Fwo �r-
WORMEN`Stj!!�LSATION INSURANCE AND RCW 18.27.
—I-
SIGNATURE jOV6*E GEbg) DATE PIGNED
A>
fir—% tALB 8 ATE
(425)
XVT
WAT
�1/ Z 3
771-0220 "FEEEASED
ATTENTION
BY ATE
EXT 1333
A
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE IL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI *
'
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
OR�GINAL - FILE YELLOW - iNSPECMTOR
D-A
P NK - OWNER GOL F:' SSESSOR
04102
PRESS HARD -YOU ARE
GREEN - ACCOUNTING
MAKING 5 COPIES