20030774.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATI
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit RWd
EXISTING — PROPOSED
Inspection Required
PREQUIRED FT
Sidewalk Required
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DEDICATION—
Wiring required
METER SI ZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 NO C3 z
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGMEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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TELEPHONE
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VARIANCE OR CUI SHORELINE OR ADBN INSPECTION B OND
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SEPA REVIEW SIGN AREA HEIGHT
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COMPLETE EXEMPT ALLOWED PROP OSED ALLOWED PROPOSED
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13 NEW RESIDENTIAL
PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
1:1 ADDITION [3 COMMERCIAL
COMPL ANCE OR
0 CHANGE OF USE
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PARKING LOT AREA REVIEWED BY DATE
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REPAIR 0 GRADING
CYDS
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REMARKS
MUST BE PRESENT FOR
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OTHER
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GARAGE , RETAININGWALL
CARPORT 0 ROCKERY
FIRE SPRINKLER
0 FIRE ALARM
(TYPE OF USE. B�U"ESS OR ACTIVITY) EXPLAIN:
CHECKED BY OF CONSTRUC ION OCCUPANT
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NUMBER NUMBER OF
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CRITICAL
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SPECIAL INSPECTION JAREA OCCUPANT
STOR_Q�?/— NITS
-NUMBER
LOAD
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DESCR& WORK TO BE DONE
REMARKS
PROGRESS� INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
C4 Surcharge
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION-
Engr. Review
PERMIT APPLICATION: ISO DAYS
L PERMIT LIMIT! I YEAR - PROVIDED WORK 15 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
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
C-5?
5
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
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Total Amt. Due
DEEMED TO MODIFY, WANE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
ecelpt #
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
Building Official or his/her Deputy; and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAB R Do F THE2STATE OF W$HINGTON RELATING TO
FOR INSPECTION
receipt Isacknowlodged In space provided.
WORKMENS COPAWTIO CE):�VRCW 18.2!y
A S N RE AT
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SaIGNED
03
771-0220
IV 11 1
REL 9 DAT
AfTENTIOItIr,
117/
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
TIN.,JkL PROJECT APPROVAL FORM
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RECORD OF INSPECTIONS
ATE RECEIVED
PERMIT EXPIRES
orl Ur/
USE PERMIT
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CITY OF EDMONDS I NUMBER z�7 7
CONSTRUCTION PERMIT APPLI(
OVMjt.� �EE OF BUSINE3P,
MAILING ADDRESS - 1
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
JOB
ADDRESS '
SUITEIAPT#
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APP(Ov@d
RW Pam* RequVed
sueet use Perm" 1180
XISTING — PROPOSED
Inspectlon Ftaqt&;4
�OEQUIRED
sidewalk ROWW
DEDICATION— FT
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METER SIZE
LINE SIZE
NO. OF FIXTURES
I PRV REQUIRED
I
YESE3 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
DATE
'*��
FIRE REVIEWED BY
FI
DATE '01
71P TELEPHONE
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W
ir
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VARIANCE OR CU
SHORELINE OR ADB11 INSPECTION 13OND
EI-PIRA
STATE ILL M13ER CHECKED
BY,
41EXP
REO'D POSTED
I
'0�
13YEs 13NO $
SEPA REVIEW
SIGN AREA HEIGHT
PROPETAX ACOPUNT PARC 0
C EXE
COMPLETE MPT
POSED ALLOW PROPOSED
ALLOWED PRO ED
,
1:1 NEW RgSIDENTIAL PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR
[j COMMERCIAL
11 ADornoN CHANGE OF USE
0 REM ODEL muLnFAmiLy 0 SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D PROVIDED
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I F1
GRADING o FENCE
1:1 REPAIR CYDS ( X_FT)
REMARKS
FOR
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TM
T ANK
DEMOLISH K
e#ti("RET,
MUST BE
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ERESENT
REMOVAL, OR CAP
GARAGE .0 AININGWALL FIRE SPRINKLER
1:1 OFIREALARM
CARPORT ROCKERY
sees
CrYPE OF USE. BU EBB OR ACTIVITY) EXPLAIN:
CHECKED BY OF CONSTRUCTION OCCUPANT
JTYPF
GROUP
NUM13ER NUMBER OF CRITICAL
OF - WELLING AREAS
SPECIAL INSPECTION
OCCUPANT
STORIE u-40AWITS NUMBER
JAREA
REQUIRED [:] YES
LOAD
K TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
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VALUAnON
VW WON. 0
Description
FEE
Description
7FEIE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY C)ONSTIRUCTION ON THE PUBIJC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 160DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 100 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
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
Landscapelnsp.
Total Amt. Due
13EEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR LIMIT 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 OffIcial or hWW Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR COD4pOF THF4STATE OF HINGTON RELATING TO
FOR.INSPECTION
reaelptis acknowledged In space provided.
WORKMEIT$ COM 0 CEJI>TRCW 18.27.
R)FN/TPRE DATF
SIG DATE SIGNED
(425)
1, �P�' .1
771 -022 0
REI.6�W Y — -
DA7
ATTENTION ZI LXT 1 33
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
5