20030696.pdf11
DATE RECEIVED
PERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS
ZONE NUMBER D'�O,
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS
OWNERPE ME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
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MAIL�l GAPDRESS rO
LID FEE S
TESCP APPfoved
RIGHT OF WAY PER OFFICIAL STREET MAP Permit Required
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PUBLIC Aw
street Use Perritit RKd
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CITY TELEI HONE
(!!�60?xbs Ifte
EXISTING - PROPOSED inspection Required
SIftwerit Required
Underoround
REQUIRED DEDICATION- FT wiring required cl
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I YES13 NO 13
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ADDRESS
REMARKS N CONTROUDRAINAGE
OWNER/CONTRACTOR RESPONSIBLE FOR EROSIO
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CITY if ZIP
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MLUT. 8P RRESENT FOR
NAME CBL#
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ENGINEERING REVIEWED BY DATE
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DATE
FIRE REVIEWED BY
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STATE LICENSE NUMBER EXPIRAT1,QN DATE REO'D POSTED
IANCE OR CU SHORELINE 08 ADBI INSPECTION 1.
r3YEs 13NO
SEPA REVIEW SIGN AREA HEIGHT
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PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
Z2,12 4. 1,9 �WX9a
EXP , ,
NEW RESIDENTIAL 0 PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRO NT L/RSIDE REAR
COMPLIANCE OR
COMMERCIAL
0 ADDITION 0 CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED By DATE
0 REMODEL 0 MULTIFAMILY SIGN
RECiD PROVIDED
FENCE
0 REPAIR GRADING CYDS 0 ( _x_Fy)
REMARKS
OTHER
1:1 DEMOLISH TANK
IGARAGE o RETAJNINGWALL FIRE SPRINKLER
3 CARPORT ROCKERY FIRE ALARM
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OW& OF E, BUSINE OR)W11VITY) EXPLAIN:
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CHECKED BY P CON R CTION OCCUPANT
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NUMBER NUM15th Ur CR ITICAL
0 OF DWELLING AREAS
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S ECIALINSPECTION REA OCCUPANT
LOAD
STORIES UNITS NUMBER
REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUC71ON ON THE PUBLIC
Grading
2 DOMAIN (CURINS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
Engr. Review
I
PERMITAPPUCATION: ISO DAYS
PERMIT LIUM I YEAR - PROVIDED WORK 16 STARTED WITHIN 180 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
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
Fire Inspection Receipt N
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
I
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.'
Recording Leej 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
This application Is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL Building offlcial or his/her Deputy: and Fees are paid, and
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
FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN ENSATION INSURANCE AND RCW 18.27.
OF i IE DATE
WN OR DATE SUNNED 1
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1A
1-125)
771-0220 Do
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R LEASED By
ATTENTION
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
HARD
ARE MAKING 5 COPIES GREEN - ACCOUNTING
04/02 PRESS -YOU
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