20030676.pdfI
I DATE RECEIVED q
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME BLY
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ADDRESS
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CITY ZIP TELE?jiS)NE
6VM66 Kawfl- .
STATE LICENSE NUMBER EXPIRATION DATE
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PROPqff�, TAX ACCOUNT. PARCEL NO.
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PERMITEXPIRES
USE PERMIT
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NUMBER
JOB
ADDRESS (OT4-Av P4_ 15,
SUITE/APT#
PLAT NAMEISUBDIVISIO
LOT NO.
LID NO.
'!51
A
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP App"ried
RW PerrM Required
Street We Partnit Req'd
EXISTING PROPOSED
Inspectim Required
sidewalk Required
REQUIRED DEDICATION FT
underground
Wizingrequired 13
METER SIZE
LINE S
OF FIXTURES
PAV REQUIRED
1
YES C3 NO C3 z
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
11
REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
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VAFIIAIICEOR6�i—rORELINEORAD13#- I INSPECTION I BOND
BY REQ'D POSTED
SEPA REVIEW SIGN AREA , 13YEs ONO $ HEIGHT
COMPLETE EXEMPT —1 ALLOWED , PROPOSED I ALLOWED PROPOSED
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1:1 NEW _)irRESIDENTIAL
PLUMBING / MECH
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BACKS (Fr.)
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0 CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED
13Y DATE
REMODEL MULTIFAMILY
SIGN
REOD I PROVIDED
REPAIR L GRADING CYDS
o FENCE X FT)
REMARKS
DEMOLISH TANK
0 OTHER
oGARAGE RETAINING WALL
CARPORT ROCKERY
0 FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIV 4:
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CHECKED BY
OCCUPANT/
ITYPE
GROUP
NUMBER NUMBER OF
OF DWELLING
r—CRITICAL
AREAS
SPECIAL INSPECTION AREA
OCCUPANI
.STORIES UNITS
NUMBER
REQUIRED [] YES
LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D
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Description FEE DescriptIon FEE
Plan Check State Surcharge
HEAT SOURCE
%
LOT SLOPE %
Building Permit
City Surcharge
/(41 —
PLAN CHECK NO'.
VESTED DATE
Plumbing
e7 71
Mechanical
THIS PERFAIT AUT140RUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERITY ONLY. AM CONSMUCT11ON ON THE PUBUC
Grading
3 DOLUUN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERUITAPPUCATION: 180DAYS
CL PERMIT ILIMM I YEAR! - PROVIDED WORK IS STAKED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I
'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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapoinsp.
Total Amt. Due
91 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
I HERE13Y 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 QLTHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Oftlal of his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
WORKMEN'S YMMIVSATION INSURANCE AND RCW 18.27.
OF FLCIALS PIGNATPRE l�TE
SIGNATU �((GENT)
DATE SIGNI!D
(425)
I
)'. li'l.
771-0220
-
RELEASEb b
ATTENTION f F
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 RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
WNER NAM7E SUSINESS
MAILNG ADDRESS
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CITY ZIP ITELEPHONE
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NAME
ADDRESS
CITY
'ELEPHONE
NAME
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ADDRESS I
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CITY ZIP
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STATE LICENSE NUMBER
EXPIRATION DATE BY
6t,tIMP1410ED0
2,111LI
PROPEPTYJAX ACCOUNT PARCEL NO.
[3 NEW —I<RESIDENTIAL
PLUMBING MECH
IADDMON [j COMMERCIAL
D
COMPLIANCE OR
CHANGE OF USE
0 REMODEL MULTIFAMILY
0 SIGN
GRADING [3 FENC
REPAIR CYDS ( X FT)
DEMOLISH TANK
o OTHER
oGARAGE RETAININGWALL 0 F RE SPRINKLER
CARPO ROCKERY FIRE ALARM
(ME OF USE, BUSINESS OR
N:
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
I DESCRIBE WORK TO BE DONE
PERMITEXPIRES
USE PERMIT
"7'
ZONE NUMBER
JOB SUITE/APT
ADDRESS
PLAT NAMEISUBDIVISION NO,
LOT NO.
LID NO.
e"
A-
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APV--
RW Pdrmit Required
EXISTING PROPOSED—
Street Use Permit Reqd
inspection Required
Sidswatic Required
REQUIRED DEDICATION FT
Underarould
widnorequirod
METER SIZE
LINE SIZE
NO. OF FIXTURES)
PAV REQUIRED
YES13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEFRING
FIRE REVIEWED BY
DATE
DATE W
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VARIANCE OR cu SHORELINEORI INSPECTION I BOND
FIEQ'D POSTED
13YES ONO s
SEPA REVIEW SIGN AREA tiEIGHT OBED
COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED , PROP
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
REO`D
CHECKED B
SPECIAL INSPECTION
REQUIRED [3 YES
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OCCUPANT.
GROUP
OCCUFANiT
LOAD
REMARKS 2
PROGRESS INSPECTI2jS2ER UBC 108/FINAL INSPECTION REaD 1!1
x a a S! 'A M wo I P !"7-7." --. ?,.% IR
Description
FEE
Description
FEE
I
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
I
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
95tz
PLAN CHECK NO:
VESTED DATE
Mechanical
THIS pEmrr AUTHORIZES ONLY THE WORK HOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE pROpEM ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURDS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION-
PERMIT APPLICATION: IGO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STASITED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Flre Inspection
Receipt #
IN INTEREST, AGREES40 INDEMNIFY, -DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS Fort 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
Landscapolnsp.
Total Amt. Due
Recording Fee
Receipt #
I N069 LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPUCATION APPROVAL
GIVEN 13 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-
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Foes are paid, and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION;& THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN$ SXN INSURANCE AND RCW 18.27.
OFFICIALS PIGNATPRE E
M95) 4
Key
SIGN=ATU
DATE SIG
16 by
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771-0220 TE LUs P
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A,rr m inm r-A 1 1 03 .
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I I 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
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU AREMAKING 5. COPIES.
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