20030828.pdf4
DATE RECEIVED 14,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
JO///V SJOLL dACXfR
MAILING ADDRESS -.&LL
Ully
FLIAOIDDS ZIP TELEPHONE
20
NAME
ADDRESS
CITY -7
NAME
ADDPj,
TELEPHONE
ZIP TELEPHONE
I-N 0
- /21// —/ / 1) %
L
STATE LICENSE NUMBER EXPIRAT
R,60C (jff��4?a
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
rtq& RESIDENTIAL
0 ADDITION
0 COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYCIS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS A EXPLAJN:
il
OR M i , .
Z6
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
�,Q
I PERMIT EXPIRES -7�
usE PERMIT
ZONE NUMBEt�" 25T
JOB SUITEIAPT#
ADDRESS Z
ls��r _L7
PLAT NAME/SUBDIVISION NO.
LOT NO*
LID NO.
LID FEE 6
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
i ESCIR Applo"d
AW Permit "."ad
Street Use Permit Rsq'd
EXISTING — PROPOSED
lnsp*cWn Required 13
Sidewalk Required 93
REQUIRED DEDICATION— FT
Underground
Wiring required —0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES 1:1 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
IfIRE
3LL MUST BE
9V17- ENGINEERINGTANKDHC
FIRE REVIEWED BY
-7-9-1`07
NT FOR
DATE
'_� I
VARIANCE OR
OR ADB#
INSPECTION
BOND
toy DATE
I Cj;LfCKED BY
REO'D
I I
POSTED
13YEs 13NO $
6Ld5j
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSE D
ALLOWED
PROPOSED
,
I
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
PLUMBING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
L/R SIDE REAR
COMPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
SIGN
REO'D
I PROVIDED
I
FENCE
( X FT)
REMARKS
OTHER
I
FIRE SPRINKLER
FIRE ALARM
A 01; z ..... . . . . .
VVZ rg If TKO/r, IA 1-
CRITICAL
AREAS
NUMBER
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT ALITHORCMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
PERMIT APPLICATION: 100DAYS
L PERMIT LJMrr I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
I 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
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
!31 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2, 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 IN19J21191a.THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED
IN VI ;�T
01 L.TN OF THt-tABOR CODE OF THE STATE OF WASHINGTON RELATING TO
'S
WOFIK��Nl COMPENSAT110p INSURANCkAND RCW 18.27.
ONER OlnG ��h DATE SIGNID
i
"I / 1A '��
ATTENTION
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
CHECKED BY ITYPE OF CONS RUCTION C ULA, a
�iwE I GRO
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED 0 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'O
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
r
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
IA13
1,425)
771-0220
EXT 1333
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Foos are paid. and
receipt Is acknowledged in space provided.
IALS SIQNquRE DATE
1 A A /L11191
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By /DATE
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MEMO TO:
FINAL PROJECT APPROVAL FORM.
TO:
DATE:
PERMIT COORDINATOR, BUILDING DIVISION
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RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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