20030863.pdfDATE RECEIVED
-3
P17RES
PERMIT EXPIRES
USE PERMIT
ZONE
CITY OF EDMONDS
NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS zq3td I
NER NAMEINAME OF BUS
PLAT NAME/SUB DIVISION NO. LOT NO. LID NO.
LID FEE $
MAILING ADDRESS
77
7rFaCP Apporomed
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
street use Pernilt Req'd
2
inspection Required
CITY 1p TELEPHONE
EXISTING - PROPOSED Sidewalk Required 13
underground
UiRED DEDICATION- Fr Wiring required cl
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NAME
YESD NO 13 z
j
ADDRESS
REMARKS 25
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ONE
NAME CBL 11
ENGINEERING REVIEWED BY
ECDC 19.3MO
PURSUAT,7TO
ADDRESS
1; 21.11111, =Yam= -
FIRE REVIEWED BY SHALL BE INSTALLED NEAR
CITY P F PHO NE
t.
'R SHMFF
THE WATE
a_ �
aWE
EXPIRATelif DATE CHECKED'BY
INSPECTION BOND
VARIANCE OR cu SHORELINE OR ADS# POSTE
REO'D POSTE
STATE LICENSE NUMBER
I 13YFs ONO $
___ - "EIGHT
SEPA REVIEW SIGN AREA
COMPLF I E EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOU CEL NO.
'if
I
6/9 aJQ .0
EXP
NEW ESIDENTIAL PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED "NAWT"P ..2 UR SIDE REAR z
ADDITION COMMERCIAL COMPLIANCE OR
OF USE
AWATER SERVICE
CHANGE
ON TH5kTE
PARKING 06
0 REMODEL MULTIFAMILY 0 SIGN
REOD I PROVIDEAaw
L�48ASrrp NTERSnMBULDR4G
[3 GRADING FENCE
REPAIR CYCIS ( _ X_FT)
REMARKS
DEMOLISH 0 TANK OTHER
0 GARAGE RETAININGWALL F RE SPRINKLER
CARPORT 0 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR Ao"
CHECKED BY OFAOMN OCCUPANT/
ITYPE
GROUP
OrION
NUMBER UMBER OF RITICAL
L
OF rDE LING AREAS
W
CUMBER IA_
t
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
U ITS
STORIES N
REQUIRED [I YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REGO
.4 il /h I &
1111M
(JIM M e- P 74
VALUATION
Description FEE Description FEE
Plan Check
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
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT ILIMM 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 SUCCES ORS
Fire Review Plan Chh. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
I
a EDMONDS, WASHINGTON,
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp. Total Amt. Due L
DEEMED TO MODIFY, WAIVE
NOR LIMIT IN ANY WAY THE CFTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
R ecelpt #
Recording Fee
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
This application is not a permit until signed by the
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL Building official or his/tier 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
receipt is acknowledged In space provided.
FOR INSPECTION
Wol:tKMENS 99IIIiIIIRSATION INSURANCE AND RCW 18.27.
OFFI L� SIONATURE DATiE
RE WINER AGENTI DATE SIG)IED
IA.*
1,425)
111119!�46M3_
DATE
771-0220
RELEAIED BY
ATTENTI"/
Off 1333
IT IS UNLAWFUL/170 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
GREEN - ACCOUNTING
ARE MAKING 5 COPIES
G4/02 PRESS HARD -YOU
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
t
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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