20030739.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OIR NAMEAME OF BUSI ESS
ITAILING A[WRESS
CITY jW Zip TELEPHONE
[--E W C� -f -7 7t T9 -7 2-
NAME
CITY ..*' ZIP
II NAME jCBL#
=I ADDRESS
INI CITY '1�10 I TELEPHONE
STATE LICENSE NUMBEW" EXPIRATION DATE I CHECKED
PROPERTY TAX ACCOUNT PARCEL NO.
00 5-t
51 00 ooe? ? 0
NEW
RESIDENTIAL
PLUMBING/MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
Wf REPAIR
GRADING CYDS
FENCE
X FT
0 DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS
OR ACTIV" N:
NUMBER
OF
NUMBER OF
DWELLING fNL
' RITICAL
AREAS
C
—STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
-C
HEAT S06E GLAZING LOT SLOPE %
0
PLAN CHECK NO: VESTED DATE
I I /)A W)Q/ —
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOUAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t:
PERUITAPPLICATION: 180DAYS
PERMIT LIUM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 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 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 C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HERE13Y 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 VIQL&T.IoN OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WPf"ER=SATI4N INSUXNCE AND RCW 10.27.
OGN*U ATE SIGNED
ATTENTION
I
Lp ERMIT EXPIRES
USE
ZONE I?
PERMIT /q
NUMBER
JOB
ADDRESS I () Zo
Pu +
PUITE/APTO
0 r I Uel
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Appmod
RW POMM 11"uIred
Street Use Parmn Rsq'd
EXISTING — PROPOSED
Inspectlon Nquired
SIdewsA nequiracl
REQUIRED DEDICATION—
FT
UndKWMM
I Wking rsqukod
METER SIZE
LINE SIZE
I
I NO. OF FIXTURES
I PFIV REQUIREO
YESE3 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY
DATE
DATE Lu
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
REO'D
10YEs Ggo
BOND
POSTED
1$ .—
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
_XP I
,
,
LOT COVERAGE
ALLOWED PROPOSED
35% IqC,
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
2.5 to Z�g
PROPOSED SETBACKS (FT)
FRONT LJRSIDE REAR
107 �4,61 _ 16-7 R
PARKING
REO'D I PROVID
2. 7,
U IT AREA
PLANNING REVIEWED By
DATE
24&91
REMARKS
I -Z J C'l AY Af4AF1h_ 1— .1 AMIZ —11�-A,;. I
rro,y� #%.w
____red An!A - 10 yaav� 6e.46t&i4z-
:,
CHECKED BY
OP CONSTRUCTION
C�
OCCUPANT
ITYPE
I
GROUP
SPECIAL INSPECTION
JAREA
OCCUPANT
REQUIRED 0 YES
I
LOAD
REMARKS I
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
I
emdft inuf
5fv
Engr. Review
Engr. Inspection
- i
Fire Review
Plan Chk- Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
I N-o
Recording Fee
Receipt #
LZL�
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or hisiher Deputy: and Fees are paid. and
FOR INSPECTION
receipt Is acknovAedgod In space p(ovidod.
OFFICIALS SIGN ATURE DATE
111110
1,425)
771-0220
EXT 1333
RELEASED BY' DATE
IT IS UNLAWFUL TO USE OR OCCUPY A OUILUIPlU OR a I RUG I U
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING