20030736.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
SI R NAME/NAME OF BUSINESS
e)A/PvLO M, FRASER
MAILING ADDRESS
7030
CITY
NAME
ADDRESS
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CITY
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NAME
ADDRESS
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CITY
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STATE LICENSE NUMBER
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ROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
0 REMODEL
MULTIFAMILY
[—] REPAIR
GRADING CyDS
0 DEMOLISH
11 TANK
GARAGE
RETAINING WALL
CARPORT
13 ROCKERY
ITYPE OF USE, BUSINE OR ACTIVrM EXPLAIN:
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NUMBER
NUMbOh OF
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
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USE PERMIT
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NUMBER�&5
ADDRESS Sul
10 5&) tlz� '7_LS
PLAT NAME/SUBDIVISION NO. OT NO. LID NO.
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit R ked
Street Use Permit Req'd
EXISTING — PROPOSED Inapactlon Required
Sidewalk Required
REQUIRED DEDICATION— FT ridevouund
Iring req Ired 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YESD NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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FIRE REVIEWED BY D;TE lu
ON 0 A T
nON DATE
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CH
RIANCE OR CU
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SHORELINEORAD1111
I INSPECTION
REO'D
13YES W`N0
I BOND
POSTED
$ —
SEPA REVIEW
C EXEMPT
COMPLETE
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SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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EXP
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PLUMBING I MECH
PL U MB IN G I M H
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CHANGE OF USE
0 F USE
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LOT COVERAGE
ALL'
ALLOWED PROPOSED
35,4017. 15
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
.2- Z5
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
5_1 4-7
0 SIGN
PARKING
RECeD ROVIDED
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PLANNING REVIEWED BY DATE 9116
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REMARKS
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FIRESPRINKLER
FIRE ALARM
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CHECKED BY
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CRITICAL
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AREAS
SPECIAL INSPECTION
NUMBER
REQUIRED [:] YES
REMARKB
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PER UBC
GROUP 1A
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OCCUPANT
LOAD
INSPECTION REO'D
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Description
FEE Description FEE
at; a(4,4AiI14-1-1
Plan Chock
State Surcharge
FFEE
HEAT SOURCE JGLAZING % LOT SLOPE %
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Building Per -it
U5
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
32 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
I: SEPARATE PERMISSION.
2
Engr. Review
15 PERMIT APPUCATION: 180 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED 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
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a EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED ANY REQUIREMENT OF ANY CITY
Landscapelnsp.
Total Amt. Due
TO MODIFY, WAIVE OR REDUCE ORDINANCE
21 NOR Limrr IN ANY WAY THE CITYS 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 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
Building Offlclal or histher Deputy; and Fees we paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
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FFIPIALS IG DIE
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S7ZRE&nE,EI,ZR A E DATE SIGNED
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RE DATE
ArMNTION
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AA1171A� 117
10,0/4"
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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4111 Af
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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ORIGINAL - FILE YELLOW INS61E�TW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBG SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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