20030843.pdfDATE RECEIVED1
PERMIT EXPIRES
IF
CITY OF EDMONDS
USE PERMIT
ZONE NUMBERCJ�� L_3
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRES:,
OWNER NAMEINAME OF BUSINES
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRES6
LID FEE $
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TESCP APIXOVed
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ANY Permit Requited
Street Use Peffnh Reqi'd
CITY ZIP TE,',LEfHONE
EXISTING PROPOSED Inspection Required
Sidewalk Requited
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Underoround
REQUIRED DEDICATION— FT Wiring requited
NAME
METER SIZE LINE SliT7. OF FIXTURES PRV REQUIRED
I YES13 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
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OBSERVED BY CII[Y INSPECIOR
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NAME CBL#
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AFFIDAVITS SHALL NOT
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ADDRESS
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DATE
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NEw RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (Fr.)
x Ix ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
1:1 CHANGE OF USE
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REMODEL MULTIFAMILY 0 SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REPAIR 0 GRADING [3 FENCE X FT)
CYDS (
REMARKS
0 DEMOLISH 1:1 TANK OTHER
oGARAGE -1 RETAININGWALL FIRE SPRINKLER
CARPORT 0 ROCKERY FIRE ALARM
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Ha S U E GLAZING % LOT SLOPE %
Building Permit City Surcharge /67
P1 At HFCK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBUC
Grading
30 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERIPArrAPPLICATION: 180DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS 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
a EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
Landscapeinsp. Total Amt. Due &J5
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."
Recording Fee Receipt # gj:�2�%
am
I HERE13Y 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 his/her Deputy: and Fes$ are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0 ALS SIG A URE DATE
SIGNAT,4RE (OWNER DATE SIGNED
1A9
11,425)
LO
C4
771-0220
REI IfAStEf BY'
ATTeNTION
EXr 1333
IT IS UNLAWFUL TO USE 027CUPY A BUILDING OR STRUCTURE UNTIL I
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
10051
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PERMIT EXPIRES
USE PERMIT
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OWNER NAME/NAME OF BUSINE
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
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MAILING ADDRES6
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE5cF Approved 13
AW PenrA Required
street Use Peffnit Roo
CITY ZIP
TEL HON
EXISTING - PROPOSED
Inspection Req Wred
sidewalk Required
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REQUIRED DEDICATION- FT
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NAME
METER SIZE LINE SIZE NO. OF FIXTURES
PAV REQUIRED
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YES13 NO 13
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ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP TELEPHONE
NAME CIL I
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ADDRESS
9- ?o o 'Tl-b,,� 6 14 k -,e 40 2-
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STATE LICENSE NUMBER EAP19ATION DATE I QiECKED
PROPERTY TAX ACCOUNT PARCEL NO.
00 & _� 2 c)o (:�:)o 0
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL muLnFAmiLy
REPAIR GRADING CYDS
DEMOLISH TANK
oGARAGE [3 RITIAININGWALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS -OR ACTN7M EXPLAIN:
'S. —
RL
NUMBER NUMBER OF
OF . JES7R ELLING
STOR 8
DESCRIBE WORK TO BE DONE '
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BE ACCEPTED
FIRE REVIEWED BY
DATE I
-1 VARIANCE OR CU SHORELINE OR AD1111 I INSPECTION i BOND
B REO'D POSTED
I 13YES 13NO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT I ALLOWED . PROPOSED I ALLOWED , PROPOSED
APLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
El CHANGE OF USE I I
PA KING LOT AREA PLANNING REVIEWED BY DATE
SIGN REOD I PROVIDED
[FENCE
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FIRE ALARM P;
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CRITICAL
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Description FEE DescrIption FEE
Plan Check State Surcharge
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&#rt3CE , j I GLAZING % LOT SLOPE % ]Building Permit C4 Surcharge 16-
P1 HECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
k:
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATIOlt ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 18 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
'EDMONDS,
Fire Review
Plan Chk. Deposit
IN 1NrEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTILY OR INDIRECTLY
.
...............
.........
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF TH19 PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO'fNFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMAI10N
APPLICATION
APPROVAL
C31VEN IS CORREcr 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building OMcIW or his/her Deputy: and Fees are paid, and
receipt is acknovAodged in space provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
LS SIGINq URE DATE
IGNA'ORE (OWNER ENT
DATE SIG ED
IA-25)
771-0220
DAE
ELgAdhd BY'
ATTENTION 771
Off 1333
IT IS UNLAWFUL TO USE 0 6CUPY 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
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