20030708.pdfDATE REC :EIVED
ERMIT EXPIRES
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CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS
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OWNER NA fiNAME OF BUSINESS
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Street Use Parnill
EXISTING — PROPOSED Inspection Required
Sidewalk Required
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REQUIRED DEDICATION— FT Wiring required
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NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
ADDRESS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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REMARKS
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(TYPE OF QGE, BUSINESS OR ACTWM.PMAN:
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LOAD
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORCMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DONIAIIN (CURBS, SIDEWALKS, DRIVEWAYS, UARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION-
t:
Engr. Review
PERUITAPPILICATION: 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STAffMD 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 MATURE. ARISING DIRECTLY OR INDIRECTLY
NOT BE
FROM THE ISSUANCE OF THIS PERMTT. ISSUANCE OF THIS PERMIT SHALL
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due —DL ')
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt # !ej nj�6;i
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
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 OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Oftial or hi0or Deputy: and Foos are paid, and
receipt Is acknowledged in space provided.
WORKMENS,CAWnSAT90;Q�URANCE AND RCVV 18.27.
OFFICIALS SIOVATURE DATE
SI DATE VNED
AI3E1N:7)6LZ
47116
(425)
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771-0220
-RELEXSED BY- DYE
ATTENTION
EXT 1333
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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
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�.t)ATE RECOVIII)
PERMIT EXPIRE S
USE PERMIT U,3
CITY OF EDMONDS ZONE NUMBER
JOB SUIMAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
DR.
OWNEF% NAYEIN-AME OF BUS114ESS
4 A 11FRA1 E PSC 14 1 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADQRESS LID FEE $
TESUP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PemA Required
Q))Q Sueet Use Perrnh Reqd
TELEPHONE EXISTING 'PROPOSED Inspoedon WuLred
CITY Z16 I Sidevrabc Required
on 0— REQUIRED DEDICATION Fr underground
Mao of;� 7 74 7 witingrequired 13
-NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV RE12UIRED
YES13 NO C3 z
ADDRESS REMARKS
OWNERVCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
A YA
CITY ZIP T ELEPHONE
NAME L
F 7W
2 co. -nic ENGINEERING REVIEWED BY DATE
ADDRQM
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FIRE REVIEWED BY DATE
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CITY— ZIP TELEPHONE
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VARIANCE OR cu SHORELINE OR ADBO INSPECTION I BOND
STATE LICENSE NUMBER EXPIRATION DATE BY REO'D POSTED
[3YES 13NO s
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
103- 2= Q do EXP ,
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C:
irn 8
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE! REAR
W
COMPLIANCE OR
0 ADDITION COMMERCIAL FISH
CHANGE OF USE
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REMODEL MUtTIFAMILY SIGN REQ`D. I PR VIDE PM
"..W- OR CA
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32 r.�
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FENCE _4116 .
1:3 REPAIR GRADING CYDS X FT) REMARKS
DEMOLISH TAN K o OTHER.
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
frYPE OF YSE. BUSINESS OR ACTMTYL&XPLAIN: CHECKED BY I=CrrLON OCCUPANTR
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7�7
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NUM13ER UMBER OF RITICAL
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OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
LOAD
ITIM
C3
STORIES UNITS NUMBER REQUIRED
[3YES
0
DESCRIBE WORK TO BE DONE
0
REMARKS TION REaD.
PROGRESS INSPECTIONS PER LIBC I 08/FINAL INSPEC
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010
1 1WE 7 1 IUSe 7A-lu P� Z? 7r Ai e
ic"tO4 U e/0 S alvd VALUATION
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CA P_ $
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Description
FEE
Description
FEE
Plan Check
State Surcharge
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HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
C,
VESTED DATE Plumbing
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PLAN CHECK NO:
Mechanical
THIS PERurr AunioAlZES ONLY THE WORK NOTED. THIP PERMIT COVERS WORK TO
1: BE DONE ON PRIVATE PROPERTY ONCE ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURN, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
1: ___
Engr. Review
2
PER ITAPPILICATION: 180DAYS
PERMIT UMrP I YEAR - PUROVIDED WORK IS STARTEDWITHIN 180 DAYS
Eqr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
PI
Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
- .111 il-
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
.
I
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
BE
,b - - —
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
T
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CM ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECII� 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 parrrJt until signed by the
CALL
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'SSAMPEtiSATlgl$;(4kURANCE AND RCW 18.27.
Building Official or IrdsMer Deputy: and Foes are paid, and
FOR INSPECTION receipt is acknowledged In space provided.
..c E
OFFMAL uy—,
ER PfAbErNT))� (425)
DATE !rNEDZ k
h,
�v
-e,� 771-0220
RELEASED 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. USC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING