20030819.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY
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NAME
ADDRESS
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ZIP TELEPHONE
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TELEPHONE
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ADDRESS,V,.
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STATE LICENSE NUMBER EXPIF)ArOj DATE
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PROPERTY TAX. ACCOUNT I!ARC*L NO.
PERMIT EXPIRES
USE PERMIT
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ADDRESI,� 2 e-d M Ll �/L
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APprov0d
Rw Perm" Required
Street Use Permit R00
EXISTING — PROPOSED
inspection Requited
Sidewalk Requited
REQUIRED DEDICATION— FT
Underomund
"umg, — 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 NO C3 z
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE, R
REVIEWED BY DATE
FIRE REVIEWED BY DATE i 111r,
VARIANCE OR CU SHORELINE: ORADBN I INSPECTION 1$ BOND
REO'D POSTED
YES 13NO
SEPA REVIEW aN AREA HEIGHT
COMPLETE . EXEMPT ALLOWEIOC , PROPOSED ALLOWED , PROPOSED
NEW
RESIDENTIAL
PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
I
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT LIFISIDE REAR
I
0 ADDITION
COMMERCIAL
COMPLIANCE OR
13 CHANGE OF USE
.. . I
PARKING
LOT AREA
PLANNING REVIEWED 13Y DATE
[] REMODEL
MULTIFAMILY
[] SIGN
REQPD
I PROVIDED
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MARSHAL
0 REPAIR GRADING Lj FENCE
CYDS X — FT)
REMARKS
bt VhESENT FOR
TANK 0 OTHER
TANK
FIEE, SEMOVAt, OR
p�__ —
DEMOLISH
GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
UWE OF LkSE, BUSINESS %
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CHECKED BY
ITYP
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OCCUPANT
GROUP.��
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL '10V
AREAS
SPECIALINSPECTION
occupANT
STORIES
UNITS�
NUMBER r
REQUIRED YES
JAREA
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108MINAL INSPECTION REaD
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Description
FEE
Description
FEE
I%
Plan Check
I
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
t: BE DONE ON PRIVATE PROPERTY ONLY. AW CONSTRUCTION ON THE PUBLIC
Grading
:23 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) VnLL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: 180 DAYS
IL PERMIT UMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
;APPUCAW
N INTEREiT. AGREES TO INDEMNIFX 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 MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
1 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 perin It until signed by the
Building Official or hi0er Deputy: and Fees are paid, and
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
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMERS C SUM AND RCW 10.27.
0 LS SIG RE DATE
StONATUI, NER 0 E DATE SWIPED
(425)
F
7�)
771-022 0
—RELEASEO'BY All
DA
ATTE
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-
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
FINAL PROJECT APPROVAL FORM
TO:
n
RE-INSpEcTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date- Si
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TE RECEIVED
PERMIT D
CITY OF EDMONDS
USE
ZONE PERMIT
NUMBE
CONSTRUCTION PERMIT APPLICATION
JOB
OWNER NAME/NAME 0
!M F BUSINESS
ADDRES��
SUITVAPT#
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
MAILING ADumESS
SeemolvT
LID FEE $
2, Allc__
A
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appproavved
RW PerwA Required
cn T
ZIP ITELEPHONE 4
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EXISTING.- PROPOSED
Street Use Peffrift R*qd
ftwilon Required
Sidewalk Required
Ire)
REQUIRED DEDICATION- Fr
u
RA -ME
WWo required [3
METER SIZE LINE NO. OF FIXTURE S
RV REQUIRED
ADDRESS
YEPs E3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY kip
NAME CBLN
F; /ro
DRESS
ENGINEERING REVIEWED BY
DATE
C ;VA ZIP TELEPHONE
FIRE REVIEWED BY
DATE
ir
i4
STLAP LICENSE NUMBER EXPIPTIO1
DATE I c HECKED BY
VARIANCE OR CU
SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
I
&46
go 5
13YES 13NO $
PROPERTY L
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
&Oxl"
,
, ,
NEW \x RESIDENTIAL
PLUMBING/MECH
EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LIR SIDE REAR
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
11
0 siGN
PARKING LOT AREA LANNIN DATE
REQ`D PROVIDED
FIR MAA§TAXBY
REPAIR 0 GRADING
FENCE
0
_I
FOR
CYDS
1:3 DEMOLISH �<TANK
X Fr)
0 OTHER
REMARKS
Mr
PRESENT
Fitt, REM906 OFt CAE
o GARAGE RETAINING WALL
CARPORT
-1 FIRE SPRINKLER
1:1
ROCKERY
FIRE ALARM
(rYPE OF LASE. BUSINESS OR LAIN:
A Al opl
M I/ V//V Cr
CHECKED BY ITYPE OF CONSTRUCTION CODE- OCCUPANT
NUIA
OFI�'
NUMBER OF
IWELLING
ITS
CRITICAL
AREAS
SPECIAL INSPECTION
GROUP
OCCUPANT
DESCPJSIE WORK TO BE DONE
NUMBER
JAREA
REQUIRED [j YES
LOAD
IfAP
REMARKS
PROGRESS INSPECTIONS PER LIBC I 08/FINAL INSPECTION REaD
Ak.
h
VALUAnON
lek
IAO�
$
Description FEE
Description FEE
Plan Check
State Surcharge
HEAT 800URCE
GLAZING %
LOT SLOPE %
Building Permit
L
IQ
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
t2:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. 1716 PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
Grading
SEPARATEPERMISSION.
Engr. Review
PERMFTAPPUCATHK- IgODAyS
PERMIT ILIMM I YEAR - PROVIDED WORK IS BTARTIED WITHIN 180 DAYS
BEE BACK OF PINK PERMIT FOR MORE INFORuAnON
Engr. Inspection
'APPLICAK. ON BE -HALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INMRIEST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Plan Chk. Deposit
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY CROINANCE
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE Crrys ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMA71ON
GIVEN Is CORRECT' AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
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
CALL
This application Is not a permit until signed by the
IN VIOLATION OFTHE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
WORKMENS W9%WASUFWqE AND RCW 18.27.
FOR INSPECTION'
Building Official or Walhor Deputy: and Fees are paid, and
receipt Is acknowl edged In space pravided.
f 7NATL ER AbE DATE NED
0 Ls SIG URE DATE
7� 7A lo 3
771 -0220
ATTENYM
EXT 1333
RELEASED BY DA;W
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
ORIGINAL -FILE YELLOW. INSPECTOR
04/02
PRESS HARD -YOU ARE
PINK-CWNER GOLD -ASSESSOR
MAKING 5 COPIES GREEN - ACCOUNTING