20030686.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO.
LOT NO�
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
its Aproroved
RW c6pirnh Required
street 11-a Permh Req'd
EXISTING — PROPOSED
Inspection Required
Sidewatit Required
REQUIRED DEDICATION— Fr —
underground
WIMC required 13
METER SIZE
LINE SIZ
X`n RES
PRV REQUIRED 43
YES 13 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
STATE LICENSE NUMBER
EXPIRATION DATE
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SPECIAL INSPECTION AREA OCCUPANT
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REMARKS
I PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REaD
1
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORRES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWAUCS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMM I 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 MATURE, 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
WOT('�WS-!!j PENSAT12��CE AND RCW 18.27.
SIGrURE (OWNt�E�" DATE SIGNED
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt It
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit unto signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknoModged in space provided.
OFFIC N URE
S4D0'
R EVE A S E
L
ATTENTION
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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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD
OF INSPECTIONS
INSPECTOR DATE APPROVED
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PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE
NUMBER 0
CONSTRUCTION PERMIT APPLICATION JOB sunE/AFr#
ADDRESS � I -
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. T NO. LID NO.
15 MAILING A13DRESS LID FEE $
7ESCP Approved
-P PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw PwM Re"Ifed
S tmei Use PeffnN RWd
CITY ZIP TELEPHONE EXISTING — PROPOSED inspection Required
Sidewa* Requirod
undetwound
M 0 ups. REQUIRED DEDICATION— FT Wiringrequired 13
NAME METER SIZE LINE S!!2. OF FIXTURES PAV REQUIRED
I YES 13 NO 13 z
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME CBL#
law—mi tj c. REVI IY
ENGINEERING DATE
ADDRESS -MA
FIRE REVIEWED
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CITY ZIP TELEPHONE
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VARIANCE OR CU SHORELINE OR ADBI INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE C REQ1O POSTED
1$
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX AMOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED SED ALLOWED PROPOSED
PROPO
EXP
LOT COVE 11AIME C KS PROPOSED SETBACKS (Fr.)
NEW RESID IM2_ JFT)
ENTIAL PLUMBING / MECH ALLOWED �LJUR193Q'Wfo LIR SIDE REAR
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COMPLIANCE OR 1XIM
ADDITION COMMERCIAL
CHANGE OF USE RIZAL nm-��
PARKING DATE
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[3 REMODEL MULTIFAMILY [:3 SIGN REOD I PROVIDED SHUTOW
116
REPAIR GRADING FENCE
CYDS X Fri REMARKS
[3 DEMOLISH 0 TANK OTHER
GARAGE FIETAININGWALL FIRE SPRINKLER
CARPORT -ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ASWN: CHECKED BY OCCUPANT
OM4C!N
ITYPE ICODE
GROUP /�
NUMBER LIM . OF CRITICAL
OF DWELLI a AREAS SPECIAL INSPECTION
I I I f4r OCCUPANT
JAREA
STORIES UNITS NUMBE LOAD
R REQUIRED [3YES
DESCRIBE WORKIro BE D
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REMARKS
PROGRESS INSPECTIONS PER UBC.1081FINAL INSPECTION REG'D
AM AM M
-ilia
I M
Li [:-Tzr%
VALUATION if r i. I
Description FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO- VESTED DATE Plumbing L111
Mechanical
TMS PERMIT At"MRIZES ONLY THE WORK NOTED. THIS PERMrT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
2 Grading
DOMAIN (CURBS, SIDEWALKS, DRrVIEWAYS, MARQUEES, ETC.) WALL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPUCATION: 180DAYS
916 PERMIT LIMIR I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK 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
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 AZ —
Landscapoinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
N OR LIMIT IN ANY WAY THE CnY8 ABILITY TO ENFORCE ANY OR13INANCE 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 M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a penrift until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building official or his/Mr Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORK4Pf8-GQ4PENSATi,CVo9?;!fMCE AND RCW 18.27.
OFFIC 8 1 UBE DATE
IG BE (OWNERTIENrT) DATE SIGNED (42
0 771-02,' 20
RELEASED B DiftE
ATTENTION EXT 1333 —met-
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A t*INAL INZirtUIIUN "Ro mr-N mmur- mNu Arr"uvt%L un t% %icniii-i- ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 GREEN -ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
a .