20030722.pdfM
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBLN
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ADDRESS
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
TAX
1:3 NEW RESIDENTIAL
BI-PLUMBING/MECH
jg ADDITION
COMMERCIAL
[3 COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
[:1 SIGN
REPAIR
CYDS
G1211
[3 FENCE X
( _ _ F7)
DEMOLISH
[3 TANK
OTHER
[3 GARAGE
I RETAININGWALL
1:1
F RE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
OWE OF USE. BUSINESS OR,ACTIVIM EXPLAIN:
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NUMBER
NUMBER OF
CRITICAL L
OF
STORIES
DWELLING
I UNITS
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
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GLAZING % LOT SLOPE %
14's Q 0/0
PLM CHECK NO: - — I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS 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: 180 DAYS
PERMIT ILIMM 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 PERMrr. 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 LAJQP-CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSA
YOWHO"CE AND RCW 18.27.
DATE STNED
PERMIT EXPIRES
USE PERMIT
ZONE 7e
NUMBERA" - L �1,
JOB SUITEIAPT#
ADDRESS
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PLAT NAME/SUBDIVISION NO..
JLO� �NO
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I L5CF Approved
RW Permit Required
Street Use Permh Req'd
EXISTING PROPOSED
Inspec-tion Required
0
Sidowelk Required
REQUIRED DEDICATION FT
Undetgr"d
Wiringraquired 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES13 NO 0
REMARKS
-OWNER/CONTRACTOR RESPONSIBLE FOR EROSION ONTROL/DRAINAGE_
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ENGINEERING REVIEWED BY
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BY -DATE—
VARIANCE OR CU
SHORELINE OR ADB11
INSPECTION
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POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE
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ALLOWED PROPOSED
ALLOWED, PROPOSED
EXP ,
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LOT COVERAGE
REQUIRED SETBACKS (170�
PROPOSED SETBACKS (Fr.)
ROPOSED
FRONT SIDE REAR
FRONT. LJR S DE REAR
AZ
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1-170
2,5, /-7.5"
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PARKING
LOTAREA
PLANNING REVIEWED, BY DATE
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REQ!_D I PROVIDED I
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CHECKED By rVPE OF; rqpNSTRU N OCCUPANT__r1':j-
5#M— 7_;V 1 T�. I GRO R-3
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED[JYES I �9_5_N I LOAD
REMARKS i
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
Description
FEE
Description
FEE
Plan Check
9a
I. �/
State Surcharge
Building Permit
J4 10
city surcharge
.Plumbing
1?7
Df.2
I&SI
Mechanical
Grading
Engr. Review
Engr. Inspection
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Fire Review
Plan Chk. Deposit
- 4q.
Fire Inspection
Receipt #
'Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
of
CALL
FOR INSPECTION
(425)
771-0220 q-
APPLICATION APPROVAI
This application Is not a permit until signed by the
Building Official or hi3ther Deputy: and Fees are paid, and
receipt 13 acknowledged In epaco provided.
OFFICIALS SIGNATURE DATE
t)tLtFkSW18Y. DATE
ATTENTION M 1333 VA 4� h 4 / zi AA
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL r g4f/ifd
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORI�&INAL_-�]?S� -'YELLOW-INSP&TOR
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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Date Signature
I:temp:bldg:fbnw:ocaprvl 3/25/04
W 'Y
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iDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPUCATION
owNEFi NAMENAME OF BUSINESS
9AP&J 44
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP !
.,INAME Cat. N
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Izi 'ADDRESS
PERMIT EXPIRES
USE PERMIT
ZONE NUMER
jolk SUITE/APT#
ADDRESS
PLAT NAM E/SUDDIVISION NO. LOT NO. UD NO.
LID FEE III
TEOW Appmed
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW PWIM Rsw"d
s"M Use Perm" 1140
EXISTING PROPOSED k"Kdon FWqWM
smewfia Rewm
DEDICATION- FT e tfr4wground
WIMCrequired 13
MiETE'RsizE LINE SIZ E NO. OF FIXTURES PRV REQUIRED
E813 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
C Awl- 1140151te-77VA115-ra, 9
IA)E: W '16 0M EWtD4 U K*�
JBINGINEERING REVIEWED BY
67
t&0.A&AWM" By JMZ"
CITY
ZIP
TELEPHONE
STATE LICENSE NUMBER
EXPIR ION DATE
CHECKED BY
PROPERW.TAX A==0
D. /
PARCEL
40 7
40
NEW
RESIDENTIAL ePLUMBING I MECH
ADDITION
COMMERCIAL COMPLIANCE OR
0 CHANGE OF USE
REMODEL
MULMFAMILY, SIGN
[3 REPAIR
GRADING
CYDS
FENCE
X Fr)
DEMOLISH
TANK
0 OTHER
EGARAGE
�CARPORT
FIETAININGWALL
0 ROCKERY
FIRE SPRINKLER
FIRE ALARM
OF
(ME USE. BUSINESS OR ACTIVTTY) EXPLAIN:
VA
'NUMBER
OF
NUMBER OF
DWELLING
RITICAL
C n L LU
A FAS
STORIES
3ER
7
SEWORKTOBEDONE
If
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VAFIIANCE OR Cu
NOAELINE OR.ADB#1
----50ND
REP-0
POSTED
1[3YES_WNO
I s
SEPA REVIEW
SIGN AREA
- . HEIGHT
COMPLETE E�X E�
ALLOWED PROPOSED
ALLOWED PROPOSED
I
7's 112-. S,
EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED 8 D
.;�WROPO
FRONT SIDE REAR
FRONT L/R.SPE WAR
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1-1710
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LOT AREA
PLANNING REVIEWED BY DATE
A PROVIDED
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CHECKED BY 'rPE
OF, 7ST
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.7-
OCCUPAN
GROUP �pt .
SPECIAL INSPECTION
REQUIRED [3 YES
JAREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION RECtD.,
VALUATION
$
Description
FEE
Descrlptl6n
FEE
_7_6
Plan Check
41
State Surcharae
HEAT SOURCE T GLAZING % LOT SLOPE %
Building Permit el CftySurqt�argpk.�,
PLAN CHECK NO: VESTED 13ATE Plumbing U*
L� Mechanical
THIS PERMITAUTHORIZE 9 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: OF, DONE ON PRIVATE PROPERTY ONLX AM CONSTRUCHON ON THE PUBILIC Grading
21 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION.
x Engr. Review
PERMIT APPILICATIOA: iSODAYS
PZRMrr UMrP I WAR - PROVIDED WORK 15 STARTED WMHIN 180 DAYS Engr. Inspection
-OR MORE INFORMATION
SEE 13ACK OF PINK PERMIT r eo
Fire Review Plan Chk. Deposit
-APPLICANT, ON BEHALF OF HIS OR HER SPO)JSE, 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 Fire Inspection Rec
ALL CLAIMS FOR UWAGiS OF WHATEVER NATURE, AMSING DIRECTLY OR INDIRECTlY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF.THIS PERMIT SHALL NOT BE LandscapeInsp. Total Amt. Due
DEEMED TO MODIFV; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
it
NOR ILIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' 1i
Recording Fe e Receipt # 7/,,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPUCATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a pomit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Offlcial or his/her Deputy: and Fees are paid, and
IND 'ON 01: THE LAPGRQODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowiedgod In space provided.
W WEN'S COMPENIPPMN9"CE AND RCW 18.27. OF IGNATURE DATE
SIGNATU AGENT) ' 1A40112%
DATE S NED 01
-5)z
771-0220 REL S BY DATE
333
ATTENTION 7gT I
;P _/ L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE I I
JNT14
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR�GINAL - FILE YELLOW - INSP(CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 - P NK - OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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