20030783A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
.21(f��T44
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBLN
ADDRESS
36,14 -`5/X7-44 744/6,6
CITY ZIP TELEPHONE
:5&:7AF L-- R-06 - 6 2 -3 - 76 -7e,
STATE LICENSE NUMBER EXPIRATION DATE BY
PROPERTY TAX ACCOUNT PARCEL NO.
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0 NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
29�COMMERMAL
COMPLIANCE OR
E] CHANGE OF USE
REMODEL
MULTIFAMILY
IKI SIGN
REPAIR
GRADING
CYDS
o FENCE x FT)
(
0 DEMOLISH
TANK
OTHER
RT
GCAARAPOE
c3 RETAINING WALL
ROCKERY
F RE SPRINKLER
FIRE ALARM
(TYPE OF USE, B4$IqESS ORjCTIVrM E?(PLAIN:
/ -1"7 1 1 PERMIT EXPIRES
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USE PERMIT I
ZONE NUMBE���_ �4�
JOB SUITE/APT#
ADDRESS 7,9 ,?1& 1 6W
PLAT NAME/SUBDIVISION N=O,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP 4pro"d
RW ParrM Requir6d
Str*M Uso Permit RoK<d
EXISTING - PROPOSED
InspecUon PAquired
SidewalkRequked
REQUIRED DEDICATION- FT -
Undagmund
WWgmquired 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES 13 NO E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
NUMBER N BEI I OF CRITICAL
UM f
DWELL NG AREAS
OF NUMBER
STORIES UNITS___ IV-k
DESCRIBE WORK TO BE DONE I
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SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO'
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q I VESTED DATE
,A .2
THIS PERMIT AUTHORIZES OHLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERUITAPPUCATION: 180 DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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
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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
wnA1(UFN1R roUPENRATIQWiNSURANCE AND RCW 18.27.
OR kOVM J I DATE
FIRE REVIEWED BY DATE I
cc
UO
VARIANCE OR CU
SH IRELINE OR A;DB�l
INSPECTION
BOND
REO'D
Zis EINO
POSTED
I $
SEPA REVIEW
SIGN AREA.
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
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PARKING
LOTAREA
IPLANNIN 0 REVIEWED BY DATE
REO`D I PROVIDED
REMARKS
CHECKED BY ITYPE
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SPECIAL INSPECTION JAREA otcukw-
REQUIRE D LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D
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- I
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are pald, and
receipt Is acknovAedged In space provided.
:OFILS SIG&NURE DATE
-L SED BY D&E
ATTENTION V f " I I UJU 1 1 . . A 1A11A0'1,1'11
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL /AflXff 7TIVIA& la& I :�z jcz�/:2
P r I __w "V
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW .4NS;JTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
VALUATION
$ 7, 666-
Description
FEE
Description
FEE
Plan Check
State Surcharge
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ffFE
Building Permit
City Surcharge
ity
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
-
--/ 7
Recording Fee
Receipt #
.V�k
CALL
R INSPECTION
1425) %_V1_
771-0220
FINAL PROJECT APEROVAL FORM
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2INSULATION ...................
Floor Insulation ......... .
Wall Insulation ...... I ......
Ceiling Insulation . ........
SHEETROCK NAILING ...
S PECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPRovAL FOR
ml
OCCUPANCY. ..................
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