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DATE RECEIVED41 Z6
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMERME OF BUSINESS
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MAILING ADDRESS
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CITY "P TELEPHONE
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NAME
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CITY ZIP ITELEPHONE
NAME
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ADDRESS
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STATE LICENSE NUMBER
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EXPIRATION DATE
/-J-04.
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PROPERTY TAX ACCOUNT PARCEL NO.
24-' 16
NEW RESIDENTIAL
PLUMBING/ MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULnFAMILY
SIGN
GRADING FENCE
REPAIR 13 CYDS ( X FT)
DEMOLISH 0 TANK
OTHER
oGARAGE o RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
I[TYPE OF USE, BUSINESS Ori AC1`lVTM EXPLAIN:
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NUMBER
OF
NUM13ER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUM13ER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: f2 a2z VESTED DATE
THIS PERMIT AUTHIORUMS ONLY THE WORK NOTED. THIS PERUff COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERUFTAPPUCAYION: 180DAYS
PERMIT LIMM 1 YEAR - PROVIDED WORK 15 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 WKXTEVER 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRE" 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-C%E OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSAIM"IJURANCE AND RCW 18,27.
86NATUR?E%
/TNER R �AGEN7)
I DATE SIGNED
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PERMIT EXPIRES
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USE PERMIT
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NUMBER
JOB SUITE/APT#
ADDRESS 2-2-51 5HUA-
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ttiur Approved
RW Pamift Required
EXISTING - PROPOSED
street Uge Permit Roq d
Inspection Required
Sidewabi Required
REQUIRED DEDICATION- FT
UndKWOund
Wring required
METER SIZE
LINE ��TNO,
OF FIXTURES
PRV REQUIRED 0
YES [3 NO 13 2;
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY oo,- DiVE
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FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU
SHORELINE OR ADBk
INSPECTION
BOND
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113 REO'D
POSTED
YES 13NO
1$ -
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROP08ED
EXP ,
,
LOT COVERAGE
REQUIRED SETBACKS (FT.)�
-PROPOSED SEYBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LiRSIDE REAR
PARKING
1
LOT AREA
I PLANNING REVIEWED BY DATE
06
REOD I PROVIDED
CHECKED BY ITYPIPOCONSTRUcIrION 7CCUPANT
_V1 (A-O% P_:;p GROUP -
SPECIAL INSPECTION JAREA OCCUPAP
REQUIRED [] YES I , I LOAD
REMARKS 9
PROGRESS INSPECTIONS PER UBC 108j'FINAL INSPECTION RECrD
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
I
Descirlptlon FEE
State Surcharge
City Surcharge
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
I a 2 �?'S4
CALL
FOR INSPECTION
1425%
771-0220
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Oilicial or his/her Deputy: and Fees are paid, and
receipt Is acknoyAodged In space provided.
O�FFICI41GNOIIRE DATE
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RELEASED"" j6ATE
R:AI 14 a
W-IS U—N-L-AW-RUL-TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGII`0L7.FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSESS�
G4/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTINi
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
l:temp:bldg:fomis:ocaprvl 3/25/04
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DATE RECEIVED A S
:r7 ERMIT EXPIRE
C wo [f. `FP
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMME OF BUSINESS
4yo -g 5-1g�
MAILING ADDRESS
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CITY - ZIP ITELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAME
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ADDRESS
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CITY ZIP,,q
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TELEPHONE
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STATE LICENSE NUMT� EXPIRAIION DATE
37"
PROPERTY TAX ACCOUNT PARCEL NO.
42 ;P 201`6 41100
1:1 NEW 13 RESIDENTIAL PLUMBING/MECH
COMPLIANCE OR
0 ADDITION COMMERCIAL CHANGE OF USE
K
REMODEL MULTIFAMILY SIGN
[3 GRADING FENCE
REPAIR CYDS X FT)
0 OTHER
-0 DEMOLISH [3 TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
WOE OF USE, BUSINESS OR ACTWM EXPLAIN:
eA 64? C_ ZA L L
Dy" _rAz
NUMBER �:7TIUMRER
'OF
h OF
DWELLING
C
CRITICAL
AREAS
STORIES
UNITS
L
NUMBER
DESCRIBE WORK TO BE DONE
LL) Uj ct er yvo ki -i r) -1'
ew
4-0% M a tP..— n. I C --% A I D.'j "".I // I I r, I 11A)
Numtsith
Jo SUITE/APT#
ANRESS 2-Z!51 HuA-y I I
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I MW Approved
RW Pamill Required
I
Surmlls-PamhRoo
EXISTING — PROPOSED
Inspection Required
SWIrwA Required
REQUIRED DEDICATION— FT
Undertiround
Wiring required 13
METER SIZE
LINE SIZE
I
7. OF FIXTURES
PRV REQUIRED
I
YES 13 , NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAG
A # 0,)j I — .6-
-_NGINEERING REVIEWED BY DJffE
:�IvbA3
FIRE REVIEWED BY DATE
_VARIANCE.OR CU
SHORELINE OR ADB11
INSPECTION
BOND
REO'D
I I
POSTED
13YEs 13NO $
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE
EXEMPT
ALLOWED
PROPOSED
ALLOWED
PRO POSED
:XP
,
,
. LOT COVERAGE
REQUIRED SETBACKS (FT.)
PR&dstr) SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
URSIDE REAR
PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
926
REO'D
PROVIDED
REMARKS
CHECKED BY
,SPECIAL INSPECTION JAREA
, REQUIRED [:] YES
REMARKS
INSPECTIONS PER UBC
OCCU
)N PANT&
GROUP
OCCUPANT
LOAD
4
ie/FINAL INSPECTION REW
0 0001
L
J"E
ISUMON hAl
IFUL TO USE OR OCCUPY A BUILDING ORSTRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A-CERTIFI- ORIGII�Al_.-,Flt� - YELL'OW-INSiIECTOR
CATE,OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - NER - GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING
F rur $
:ZA 1�11 #.%p I I V% Description FEE Description FEE
C tAL oqK mck,
Plan Check State Surcharge
HEAT SOURCE GLA23NG % LOT SLOPE %
Building Permit City Surcharge
'PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
;fHIS PERMIT AUTHORIZES OMY THE WORK NOTED. TW8 PERMIT COVERS WORK -To
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
ft I Xngr. Review
PERMITAPPLicliII& -!;;A;;7:
PERUIT ILIUM I YEAR - PROVIDED WORK IS STARTED WITHIN 18 0 DAV S Engr. Inspection
BEE BACK OF PINK PERMTT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRSi'ASSIdNSAND SUCCESORS Fire Review, Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, TrS OFFICIALS, EMPLOYEES. AND AGENTS FROM 'ANY AND Fireinspection 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 Landscapelnsp. Total Amt. Due
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.* Receipt #
Recording Fee
I HEREEN ACKNOWLEDGE THAT I HAVE REA6 THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECr AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE To COMPLY WITH CTTY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit ur
CALL Asigned by the
TION; AND W DOING THE WORK ALMIORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/hor Deputy: ffd Fees are paid, and
IN VIOLATION OF THE LABOR-CWE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowiedged In dpace provided.
WORKMENS CONIPEN83POITITOI�LlFgINCE ANT) RCW 18.27. DATE
OFFIC IGN/7�E
SrNj�TUIRE 7NER � AGEt"M DATE SIGNED IA03
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