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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATI
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PERMIT
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SUITE/APT#
PLAT NAMEISUBDIVISION NO. LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
YESCP Approved
RW ParrNt Requited
Street Use Peffnit R&q`d
EXISTING — PROPOSED
Inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION— FT
Underground
Widno required [3
METER SIZE LINE SIZE OF FIXTURES
PRV REQUIRED
1 :E.
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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INSPECTION
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NUMBER REQUIRED [I YEs LOAD
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REaD
VALUATION
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Description FEE DescriptIon FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit, City Surcharge
PLAN CHECK Ng: VESTED DATE Plumbing
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THIS PERMIT AUTHORUMS OMLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
23
Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: IGO DAYS
PERMIT UMM 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
17/
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 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 Otficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABORQ,0DE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
—WORKMEN'S COMPENSAT
��SOIiIANCE AND RCW 18.27.
OF L NATUR
SIGNATURA(OWNER C(jr
DAT SIGNED
(420%
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771-0220
6ELWED By
ATTE
M 1333
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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 - YELLavv - INSPEC 6R
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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DATE RECEIVED
PERMIT EXPIRES
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USE PERMIT
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CITY OF EDMONDS. 0 15� NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNE - R NAME/NAME OF BUSINESS ADDRESS V95 I k 161 -
I'A VAN(," V\ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
_Ky
MAILING ADDRESS LID FEE $
YESCIR Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
5L. Streat Use Permit flactd
CITY ZIP ELEPHONE EXISTING — PROPOSED IrApection Required
SiclawallcRequired
V— 4 REQUIRED DEDICATION— FT Underground n
NAME LINESIZE NO.OFFIXTURES PRV REQUIRED
YES 13 NO 13
IADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP
TELEPHONE
NAME
CBL #
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RES$
Vb Vol. 31c� on
CITY 3P
TELEPHONE
LtA 40 S-MA-14
(14o) 417- 16-7 0-1
STATE IUCENdE NUMBER
EXPIRATION DATE
HECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL
PLUMBING/MECH
ADDITION OOMMERCIAL
arc
o COMPLIANCE OR
CHANGE OF USE
REMODEL mui:
Timmwy
SIGN
[3 REPAIR 0 GRADING CYDS FENCE X
__FT)
0 DEMOLISH TMK
OTHER
0 GARAGE RETAINING WALL
1 CARPORT ROCKERY -IREALARM
(fYPE OF,USE, BUSINESS OR ACTIVITY) EXPLAIN;'
IL
ItUMBER
7,
OF,:
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
40""
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
cc
E..
VARIANCE OR Cu
SHORELINE OR ADB#
INSPECTION
BOND
REO'D
POSTED
13YEs 13NOI$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
M
EXP
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,
M
-4
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
0
M
M
PARKING
LOT AREA
PLANNING REVIEWED BY DATE A
RECID PROVIDED
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REMARKS
0
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CHECKED BY
TYPE OF CONSTRUCTION
ICODE
OCCUPANT
2
GROUP A
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SPECIAL INSPECTION
OCCUPANT
JAREA
REQUIRED
LOAD
RqMARKS
M a
PfIOGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REaD
NoWl IBM
-gal AM NMI
VALUATION
$
DescrIptIon FEE Description FEE
Plan Check State Surcharge
0
HEAT SOURCE GLAZING % LOT SLOPE % Pla M
I
Building Permit
%L.-V
City Surcharge
LO
P.LAN CH!27.,
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COVERS WORK TO
t:
11
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
1
Grading
3
DOUAIN (CURBS. SIDEWALKS, DRI'IfEWAYS, MARQUEES, ETC.) WILL REQUIRE
1:1
SEPARATE PERMISSION.
Engr. R "I
PERMITAPPLICATION: 11001DAYSk
PERMIT LIUM I WAR - PROVIDED WORK 18 STARTEIII WTTHIN 180 DJAV
Ion
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
52
Plan Chk. Deposit
N INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND,
:Ire Inspection
Receipt #
ALL CL
AIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
�Qd
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
-andscape Insp.
I
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIZ
10P �ng Fee
Recelpt #
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 CITY AND STATE LAWS REGULATING CONSTRUC-
LL
"660,
This application Is not a perinit until signed by the
TIM AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOWDE OF THE STATE OF WASHINGTON RELATING TO
FOR IN Tick
BulldkV Official or his/her r)ep*: and Fees are paid, and
recelpi Ii acknowledged In space provided.
No RCW 18.27.
WORKMENS COfAPENS�SUI"
�NCIE A
-
OF 71NATURfij nA E
(OMER 0, A
DATE 181,IGNED
1A135)
IVY&I
1:2L
W3
gqP)961�1)
771-0220
.
6EL�ZAED
By kTE
ATMWI716N
EXT 1333
/
170
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINALiF11,12 YELLOW-INSPEC,16
'
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING