20030742.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
V'�
MAILING ADDRESS
ICZ1 I 'isA
CITY ZIP I TELEPHONE
6-
NAME
133
t ADDRESS
z
CITY ZIP ITELEPHONE
NAME CBLN
U K, �'_r A
ADDRESS
_Nc-d
CITY ZIP I TELEPAoNE
STATE LICENSE NUMBER
NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIA
REMODEL
MULTIFAMILY
REPAIR
GRADING
CYDS
DEMOLISH
TANK
GARAGE
RETAININGWALL
CARPORT
ROCKERY
(TYPE OF U E, 8
ACTN" EXPLMAIN:
tT
2f
NUMBER
OF 40
!'�'a
M
NUMBER OF
D ILL
DWELLING
STORIES/S7--%
UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING %
PLAN CHECK NO:
BY
131*,PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( — X—FT)
OTHER
F RE SPRINKLER
F:RE ALARM
I
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER 7 e,*
JOB SUITE/APT#
ADDRESS
PLAT NAMFJSUBDIVISION NO. 7 NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Parnilit Raquked
Sir at Use permit Roqd
EXISTING — PROPOSED
Ins=n Required
Sidewalk flaquired
REQUIRED DEDICATION— FT
Underground
1 wining requ 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES C3 NO 13
3
15
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
'I'ype B or L vent connectors
requiled oil fuel-burnhigappulmenin
-unhented ILMC 8151.7
ENIINEERINGREVIEWEFIREIPYCeS
DATE
FIRE REVIEWED BY DATE W
cc
Cc
VARIANCE OR CU
SHORELINEORADB11
INSPECTION
REO'D
I
PBOND
OSTED
DYES ONO
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
I
. .
z
PARKING
LOT AREA
LANNING REVIEWED,BY DATE
REO'D PROW
1 14
PIPE
�EST MUST BE
REMARKS nUCCIDIIIEn
DV
f%17W 1R8nnr-rh9Po%r%
VITS
CHECKED TYPE OF SIR_4CTION
CRITICAL 1
AREAS j SPECIALI PECTIO—NOFA A
NUMBER REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONS PER UBC
LOT SLOPE %
VESTED DATE
VALUAnON
$ 's, sb
Description
Plan Check
Building Permit
Plumbing
RA11-1
OCCUPANT
GROUP
OCCUPANT
LOAD
2
INSPECTION REG'D
FEE Description FEE
State Surcharge
City Surcharge
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOPIE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
PERMITAPPUCATION:
Engr. Review
ISO DAYS
PERMIT UMM I YEAR _ PROVIDED WORK IS STARTED WITHIN 160 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
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
# 2-ae4o
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
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CRY 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 Official or histher Deputy: and Face are 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 COMPENSATI��SURANCE AND RCW 10.27.
-
SIGNATURE (OWNER AGE DATE SIGNED
F
(425)
F--- 81 RE DATE
A A., 12A
771-0220
—
ILL
RELEA6ED 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
OR�GINAL - FILE YELLOW - INSPECTOR
PNK-OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN ACCOUNTING