20030755.pdfEl
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DATE RECEIVED
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FP ERMIT EXPIRES
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
r-% I M C /ii, I 'uh!t 1 P_
PLAT NAM E/SUBDIVI SION N
LOT NO.
LID NO.
LA C� e- 1% 4v-
MAILING ADDRESS
5-36
CITY ZIP TELEPHONE
V_` S M0 7 r -71,0t;
NAME
PAC-IfIC 1E7AjjACt-&IItJS
ADDRESS I
1 -30 a V E: 1\ V MtA -410d
CITY ZIP TELEPHONE
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NAME 'jCBL#
Mk1'qNCF- FF,5j0IfLf44I01`J
ADDRESS
99B 3 13- q A v b7 1V i�--
CITY ZIP TELEPHONE
'4 0S?_ 42 S' 2--1cla?
STATE LICENSE NUMBER EXPIRATIOq DATE
IL
PROPEqjrY TAX ACCOUNT PARCEL NO. _L f
S-10, :-) 1A v "��"R_11C�
NEW
ZRESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
7 E DEL
MULTIFAMILY
SIGN
FENCE
REPAIR
GRADING
CYDS
X FT)
DEMOLISH
TANK
OTHER
GARAGE
RETAININGWALL
FIRE SPRINKLER
0
CARPORT
ROCKERY
FIREALARM
MIRE OF USE US 3S OR ACTMM EXPLAIN:
,n>-V r IL
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
Dr \1 I?oA-
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: I VEST ED DATE
__1
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Rw Permit Required
Street Use Permit Roq'd
EXISTING — PROPOSED—
Inspection Required [3
Sidewalk Required [3
REQUIRED DEDICATION— FT
Underground
Wlring,equllad
METER SIZE
LINE ��.
OF FIXTURES
PRV REQUIRED
1
YES C3 NO 13 9
5
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU
SHORELINE OR ADBII
INSPECTION
BOND
REO'D
I
POSTED
I
13YEs 13NO
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
I
ALLOWED PROPOSED
EXP I
,
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
z
z
BY
DATE
PARKING
REO'D PROVIDED
LOT AREA
I PLANNING REVIEWED
REMARKS
CHECKED BY ITYP!:MUCTION Cff�k OCCUPANToa,
GROUP is Z -1
SPECIAL INSPECTION JAREA OCCUPANT
I REQUIRED [:] YES LOAD I
IREMARKS I
1PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD 1 9
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
State Surcharge
7
City Surcharge
!.—A
I
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapeinsp. Total Amt. Due .41
Receipt #
Recording Fee t�7
,9 �� I
APPLICATION APPROVAL
This application Is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
OFFICIALS SIGNATURE DATE
(425)
— qZ 14114�, 4.
771 -0220 �'FIEL a DATE(
E)Cr 1333 L INEZ 2>
111 90 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL J4 . YELLOVI- INsPa6TC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINKJOWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTV ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERmrrAPPILICATION: 150 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
114 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 CITYS ABILRY 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 C17Y AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
14 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIO"Sk��ANCE AND RCW 18.27.
SIGNATURE (OVVER OR t.�N`ril DATE 1IGNED
Oct 7--L
IT"_141 103
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