20030695 (2).pdfI
C4 DATE RECEIVE�,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
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CITY ZIP I TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
ADDRESS ell ilia
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CITY,' ZIP
STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO.
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TELEPHONE
93
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB
SUiTEjAPT#
ADDRES��'J,,�
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TFSCP App,
Aw Pr.4 "=ad
Street Use Peffnit Roq�d
EXISTING — PROPOSED
Inspection Floquired
Sidewalk Required
REQUIRED DEDICATION- FT
I Underground 13
METER SIZE
LINE SIZE
:S
PAV REQUIRED
YES13 NO 13 z
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
REVIEWED BY DATE
FIRE REVIEWED BY DATE 1 11
r- -/ ;- 'A I/ _/
VARIANCE OR CU
—*,HO ELINEORADB#
I INSPECTI ON
BOND
EXPIRATION E
CKED I
CHECKED BY
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POS TED
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FIT
YaR
$
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SEPA REVIEW
SIGN AREA
N HEIGHT
COW&ETE EXEMPT
AL WED PROPOSED
ALLOWED
PROPOSED
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M.
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EXP Q�
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INGIMECH
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LOT COVERAGE
REQUIRRED SETBACKS (FT)'
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FROM
OR
LIANCE OR
S
GE OF USE
PARKING t=EA
REO'D PROVIDED
LAL%4NING REVIEWED BY
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REMARKS
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PRINKLER
ALARM
NEW RESIDENTIAL PLUMB
COMP
ADDITION COMMERCIAL CHAN
REMODEL MULTIFAMILY IGN
F
REPAIR GRADING CYDS ENCE
DEMOLISH TANK 0 OTHEf
oGARAGE RETAININGWALL [:3 FIRE S
CARPORT ROCKERY FIRE
(TYPE OF US OR N:
)5
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES I M& I NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK &0.*,ft VEST�D DATI�
THIS PERMIT AUTHOnIZES ONLY THE WORK NOTED. THIS PERMIT JfOVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT UMIr 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 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 CITYS 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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
8 WM��Wd rip
'..,,�AGENT)
DATE SIGNED
CHECKED BY ITYPUF CONSTP,UCTION CODE OCCUPANT
GROUP
SPECIAL INSPEC:,7niQNAR1iA OCCUPANT
REQUIRED [I YES LOAD
REMARKS
1PROGRESS INSPECTIONS PER 1.11810108MINAL INSPECTION RE 'D I
Description
FEE
Description
State Surcharge
FEE
Plan Check
Building Permit
City Surpharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
�7i
CALL
FOR INSPECTION
I -Tr-
1Aq5)
771-0220
APPMATION APPROVAL
This application Is not a permit until signed by the
Building omcisi or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
OPE'ALS S" ATURE
71 ki ZAA i /) /A.4
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6,d14etDT=e9Yg64*'�L D TE
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ATTENTION Off 1 33 h3i
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL T—///,/ 2/,? mk
I '�ILE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- L_41GINA - YELLOW! INSftCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -'OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
1
M
DATE RECEIVE
PERMIT EXPIRES
PERMiT
ZONE NUMBER
CITY OF EDMONDS JOB 4!�&_ 19 _10
CONSTRUCTION PERMIT APPLICATION ADDRES��j Bull 0
A
OWNER NAME/NAME OF BUSINESS LID NO.
C-4 PLAT NAME/SUBDIVISION NO. LOT NO.
LID FEE $
MAILING ADEIRESS
"'P
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP w d
R
street so erm I
Inspec,don ReqWred
CITY Zip TELEPHONE EXISTING — PROPOSED 51dowalk Requirad
Undargrotmid
9,;- REQUIRED DEDICATION_ Fr WWg required 13
e- 1,JA OJ
)0j.
ETER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NAME z
YES 13 NO 13
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
CBLj
NAME
ENGINEERING R E
WEVIEDBY
C-31
ic ADDRESS
z:
FIRE REVIEWED BY DATE Lu 0
Ic
CITY ELEPHONE
ZIP IT
P:?
PECTION BOND
VARIANCE OR cu ORELINEORADB# INS
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY LAPT RE%2 POSTED
10 001bYES_#19%Q $
"SIGN AREA, HEIGHT
SEPA REVIEW- D
PROPERTY TAX ACCOUNT PARCEL NO. co EXEK!PT _QSED
-.ALLQWED PROP ALLOWED PROPOSE
7M I 0M
EXPY
ji,.�4_-,f� 1 f a 60 7ieO w5lit"71 — il ,
REQUIjRD SETBACKS (k)l PROPOSED SETBACKS (FT) M
PLUMBING/MECH LOT COVERAGE "0Wi%-4""L_LE.A.R. 1 -4 § I ':
NEW RESIDENTIAL ALLOWED PROPOSED FRONT WDE REAR
0
COMPLIANCE OR .....
ADDITION COMMERCIAL CHANGE OF USE
PARKING LOT AREA 1Y.I.VNING REVIEWED BY DIES,/ M
MULTIFAMILY SIGN REOD PROVIDED q_�j
�!�MqDq� �, _w
NwAb
All C_
[3 FENCE z
REPAIR GRADING CYOS X FT) REMARKS
OTHER
DEMOLISH 0 TANK
0
RETAJNINGWALL 0 FIRE SPRINKLER
GARAGE
CARPO ROOKERY FIRE ALARM "n
VYPE OF US BUSINESS OR ACTIVITY) EXPLAIN: CODE OCCUPANT
CHECKED BY TYtf,.PF CONSTIlUCTION GROUP
cm. I ff ..w M
NUMBER NUM13ER OF CRITICAL SPECIAL INSPECTION JAREA OCCUPANT
OF DWELLING AREAS
STORIES UNITS NUMBER REQUIRED YES LOAD
DESCRIBE WORK TO RE DONE
REMARKS" ic
PROGRE19S INSPECTIONS PER USC I 08/FINAL INSPECTION REaD
211. VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
LOT SLOPE % A!2b^ 0
HEAT SOURCE GLAZING % Building Permit City Surpharge M
VESTED Plumbing
PLAN CHEC:L
Mechanical
IT AWERS WORK To
ED. TH 8 PEAM
THIS PERMIT AUTHORIZES ONLY THE WORK NOT
HE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
N DOMIAIN (CURBS. SIDEVALICS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3 SEPAMTEPEMISSION.
9 Engr. Review
I PERMITAPPLICATIOW. 111110DAYS
96 PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
-&ppiifAhrrON HALF OF HIS OR HER SPOUSE, HEI ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY CF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
#
;01-
ALL CLAI Ms FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMFE ISSUANCE OFNHIS PERMIT SHALL NOT BE
I
Landscapelnsp.
lRecelpt
Total Amt. Ducal
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Ipt #
Receipt #
Recording Fee
ce
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION; THAT THE INFORMATION
APPUCATION
IPR20�VAI
C31M IS CORRECT: AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE.TO COMPLY WITH CITY AN D STATE LAWS REGULATING CONSTRUC-
AL
'This application is not a permit until signed by�tha
Building omcW or hlsftw Deputy: and Fees are paid, and
TION; AND IN DOING TilE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
F I SPECTI N
receipt Is acknooriedged In space provided.
WORKMEWS COMPENSATION INSURANCE AND RCW 16.27.
URE *T
F LS SIGN E
E ATE SIGNED
IA9
771-C )220
RE E
ATTE NTION &A&YI �O Lk�IDB '504" Vo
EXT 133
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUMTEtUNTIL
fINSACTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
GIN FILE YELLOW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PRESS HARD -YOU ARE MAKING 5 COPIES
--bWNER GOLD -ASSESSOR
PINK GREEN - ACCOUNTIN
04/02