20030859.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINME OF BUSINESS- f
MAILING ADDRESS
CITY ZIP TELEPHONE
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ADDRESS
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ADDRESS
I PERMIT EXPIRES
PERMIT
NUMBERCWL
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCF Approved
RW PonTA Required
Strest Use Permit Wd
EXISTING — PROPOSED
inspection Required
SidowmARequirs,cl
REQUIRED DEDICATION— FT
UnderDround
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES C3 NO 13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
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NAME
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STITEIMENSE NUMBER EXPIRATION DATE CHE0Ke5'B`f-.,,
VARIANCE OR CU SHORELINEORW-91 INSPECTION BOND
POSTED
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YES ONO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
101= �>11 ilk
EXP ,
)§,..RESIDENTIAL PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
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CHANGE OF USE
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PARKING LOT AREA NINO REVIEWED BY DATE
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(TYPE OF USE, BUSINESS OR CT TY)
CHECKED BY TYPE OF COUCTRI.19MON OCCUPANTf% I
GROUP
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NUMBER N ER OF dRITICAL
OF OWES N
U (3 AREAS
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SPECIAL INSPECTION JAREA OCCUPANT
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STORIES UNITS -NUMBER
REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 1 06/171NAL INSPECTION REGI'D
U. A t A,
%
AM fM
VALUATION
$
Description FEE Description FEE
Plan Chock State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
a
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBUC
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: 180 DAYS
UMM I YEAR - PROVIDED WORK IS STARITIED 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMff. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 N R umrr IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
I 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 C17Y AND STATE LAWS REGULATING CONSTRUC-
ThIs application Is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees 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 COMPENSy4qTWP4V'ANCE AND RCW 18.27.
I URE DATE
IG URE (OWNER 01 -AGE — DATE Sl NED
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oAa&
7714)220 I
6EL9ASf1D_BY`_ DAA
ATTENTION
Off 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
IM
-L,DATE RECEIVED)i
PERMITEXPIRES A/
USE PERMIT
ZONE NUMBER
CITY OF EDMONDS
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ADDRESS
OWNER NAMENME OF RUIINE 40 (o
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 7�
MAILING ADDRESS. LID FEE S
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW ParrrA"Rewired
_Uy, svw use Permit RWd
CITY C) EXISTING — PROPOSED Inlipwdon FlecItired
ZIP TELEPHONE Sidewalk RaWked
REQUIRED DEDICATION— FT Undwwound
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M-IL PRV REQUIRED
NAll METER SIZE LINE SIZE FNO, OF FIX
YES 13 No E3
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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FIRE REVIEWED BY
DATE
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TE ICENSE NUMBER EXPIRATION DATE CH REO'D POSTED n
YES 13—
SEPA REVIEW SIGN AREA HEIGHT M i
1" 015-LICY
ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
PRE�ERTY TAX
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EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (F-1
RESIDENTIAL "Zial-I
[:] PLUMBING/ME ALLOWEEI�
PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
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COMPLIANCE OR rn
DITION COMMERCIAL (-4 e 'l - I i,-V & `,:�c
CHANGE OF USE
PARKING LOT AREA 1,11�ANING REVIEWED BY �DATS,,,
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ff"F116PORESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECM.
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VALUATION
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Description FEE Description FEE
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Plan Check State Surcharge
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HEAT SOURCE GLAZING % LO`r SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
ta Mechanical
TMS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMrF COVERS WORK TO
BE DOME ON PRIVATE PROPERTY OHM MY CONSMUCTION ON THE PUBLIC Grading
90MAIN (CURBS, SIDIEVALKS. DRIVIEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
Engr. RWmv
PERMTTAPPLICATIO;k 1160DAYS
PERMIT LIMIT! I WAR - PFICMDE!) WORK 18 STARTED WITHIN 180 DAYS Engr. Inspectio
BEE 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
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
Rece
ALL CAAMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT HE
Landscape Insp..L.
Total Amt. Due
Total
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILrrY TO ENFORCE ANY ORDINANCE PROVISION.'
Rece ipt #
Recording Fee
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 REGY LATING CONSTRUC-
CALL
This application Is not a permit until signed by the
AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSOW WILL BE EMPLOYEE)
Building official or hl"r Deputy: and Fees are paid, and
4
TION;
IN VIOLATION 010 THE LAqg&CODE OF THE STATE- OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknovdodged In space provided.
WORKMEN$ COMPENS2!�CE AND RCW 18.27.
9F I"URE DATE
SIGNA,TURE (OWNER ol
DATE 811,NED
7
1A* 5
40ff
ll
771-0220
IM24L 11)
�`EASEO
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REM
ATTENTION
W 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR,#% CMTJFI-
ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
04102 PRESS HARD -YOU ARE MAKING 5 COPIES