20030844.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
or
;r a r 1-e e vi etj r&tY-
MAILING ADDRESS
A65 2-rld ",,5. �j
CITY ZIP I TELEPHONE
s qko2�0 I qz,� -7� p7Sy
NAME
ADDRESS
CITY ZIP TELEPHONE
NAMP h e_- CBL N
L2-70
ADDRESS
-2 CIA-% "T�14d%�, &, &hg�
ouo
X TELEPHONE
I
STATE LICENSE NUMBER EXPIRATID)N DATE CHFPKED BY
LV A--tk IeSq -7 (e)17 c112�
r1i I
PROPERTY TAX ACCOUNT PARCEL NO.
0 55 Ll ?z woo e) t/ 00
NEW RESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE 08
9CHANGE OF USE
REMODEL MUILTIFAMILY SIGN
GRADING o FENCE
REPAIR CYDS X FT)
DEMOLISH 11 TANK [3 OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
W1rPE OF US E
,L,BUSIN §§ OR ACTINTM EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS j NUMBER.
DESCRIBE WOF1k TO 13E DONE
—1 nkf i I I 4Z r evor'- C e /j vlz
It L/V -
.71 V RYD
-Cv-"' I P1
RT
4- 5 1 JRCE GLAZING % LOT SLOPE %
CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPEIM ONLY ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
I PERMIT APPLICATION: 180 DAYS
PERMIT LlMrr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 INDEMNIFX 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 VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
C
WORKMEN!S COMPENSATION INSURANCE AND RCW 18.27.
k1GfjWRE QDWN�ER OPNENTY/ 819NED
, I DITE,
PERMITEXPIRES —a
USE
PERMIT
ZONE
NUMBER
JOB
ADDRESS
ao 21b
ases - ;;:2 / y��,A/
SUITE/APT#
p, NAME/SUBDIVISION NO.—FOT
ma-
NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW permit Requited
EXISTING — PROPOSED—
Street Use Permll Rsqd
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underomund
Wirin required
METER SIZE. LINE SIZE NO. OF FIXTURES
PRV REQUIRED
I
YES13 NO 1:1
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING
BE ACCEPTED
FIRE REVIEWED BY DATE
JARIANCE OR CU SHORELINEORADB11 I INSPECTION I BOND
REQ`D POSTED
13YEs ONO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRO NT UR SIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED I I
CHECKED BY
GROUP
SPECIAL INSPECTION" JAREA OCCUPANT
REQUIRED [] YES I LOAD
z
z
REMARKS 2
PROGRESS INSPECTIONS PER Ul3C'I 08/FINAL INSPECTION REO'D
nagal'GIOSS Of Whether the water system
ALUATION anslon tanks are
V 1. __ _. 0 1 1 re
rAll'111111 etn nil ^4
$ tanks vei
de. EQUI 30 020(,.G-
DescrIpUon
8 04A&W"
Plan Check
State Surcharge
Building Permit
City Surcharge
b5
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapoinsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
IF C LS SIG E DATE
_2APR
C�m / ,,12'12cV6-;).
RELEASED BY D;rE �`
ATTENTION I,/ 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
z
0
IT!
M
0 C:
M
171
C _z
0 _Tl
.Tl
ITI M
0
C
0
z
0
IT!