20030888.pdfI
DATE RECEIVED PERMIT EXPIRES 6—T , �z
177NER 16K
USE PERMIT
CITY OF EDMONDS ZONE NUMBER /APT#
JOB _7�
CONSTRUCTION PERMIT APPLICATION ADDRESS z-)
LID NO.
OWNE NAMFjqiiE �F BU�INCSS PLAT NAME/SUBDIVISION NO.
LID FEE $
...... ...... IESCP ov
MAILING ADDRESS PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP RW at "M11 R uIred
Stre Use Peffnh RWd
Ins 'In
EXISTING � PROPOSED Sid elk Requ
ZIP TE PH NE Underground
REQUIRED DEDICATION— FT Wiring requir [3
. —7 OF FIXTURES PRV REQUIRED
NO.
ER SIZE LIN z
r ET E SIZE
NO 13
YESE3
NAME
ic z
REMARKS ACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
OWNER/CONTR
RVS%
Z T
CITY tj ��2 - - .1
45
E DATE
ENGINEERING REVIEWED By
ADD SS DATE tu
FIRE REVIEWED BY M
z
TELEPHONE
BOND
Lf SHORELINE OR A&BN INSPECTIO POSTED
VARIANCE OR CU REO'D
0
EXPIRATI AT CHECKED s ONo s
STATE LIC ENS N MB HEIGHT
EA
SEPA REVIEW D ALLOWED PROPOSED
LJD�r D 55 DW EXEMPT ALLOWED PROPOSE
0 - COMPLETE
Coo
PROPERTY TAX Accuum I PARCEL NO.
f';� EXP (FT
C) 0 0 4 ol QUIRED SETBACKS (FT.) PROPOSED SETBACKS
LOT COVERAGE RE DE REAR
R FRONT UR SI
M
PLUMBING MFCH ALLOWED PROPOSED FRONT SIDE REA
0 RFSIDENTIAL z
I[=
M
0 NEW
C MpUANCE OR
0 ED BY DATE
ADDITION COMMERCIAL 0 CHANGE OF USE PARKING LOT AREA PLANNING REVIEW
-40
0 r
RECfD
MULTIFAMILY SIGN _LT2!!aE
0
M
REMODEL
FENCE
GRADING CYDS 0 ( _X,Fr) REMARKS
REPAIR
10
0 OTHER
DEMOLISH TANK
RETAININGWALL [3 �IRE SPRINKLER
WAGE At AC31LA
17-1 ROCKERY Oc UPANT
c
0 _111 I
NSTQUCq1ON
(TYPE 0 F USE. BUSINhbts On AGIMM EXPLAIN: CHECKED GR UP
74 1
1E OCCUPANT
CRITICAL NSP ECMTIONAR EA
SPEI��:1111111'11 I LOAD
NUMBER NUMBER OF AREAS
M M
OF DWELLING vAn NUMBER REQUIRED
UNITS
STORIES z
IBE WORK TO BE DONE EMARKS
I 'PECTIONS PER UBC 108/FINAL INSPECTION REGILII
DESCFt
Fn
0)
ROGRESS
ic 0)
4f
M 0
46,
VALUATION
$
Desc ription FEE Description FEE
State Surcharge
_w.
Plan Check
z
city Surcharge
OT SLOPE % mit
LAZING % Building Pe
0
-4
HEAT SOURCE
5
V STED DATE Plumbing
M
PLAN CHECI��
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WORK TO
CONSTRUCTION ON THE PUBLIC Grading
ANY
BE DONE ON PRIVATE PROPERTY ONLY. S, MARQUEES, ETC.) WILL REQUIRE
SIDEWA
2 DOMAIN (CURBS, ISSION. Engr. Review
:3
2 pERMrrAppUCATION: ISODAYS Engr. Inspection
15 ARTED WITHIN ISO DAYS
WORK 15 ST
a. PERMIT umm I YEAR - PROVIDED
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
AGREES TO INDEMNIFY., DEFEND AND HOLD HARMLESS THE CITY OF ction Receipt #
AGENTS FROM ANY AND Fire Inspe
IN INTEREST.
WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND
x EDMONDS, WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY Total Amt. Due
MAGES OF r ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp.
INANCE
ISION.* Receipt #
Recor ng Fe
p ATION APPROVAL
RMATION
GENT OF his pplication is not a painnit until signed by the
H NSTRUC- CALL ng sIfficial or his/her Deputy: and Foes are paid, and
GI MPLOYED f ecolpt is acknoModged in space provided.
TH EREBY, N
U iZE FOR INSPECTION
ING TO
TION; AND IN DOING E WORK
0 1 IALS SIrAXURE DATE
IN VIOLATION OF THE LABOR C BE F T E STATE OF WA I GTON RE
WORKMENS COMPENSATION INS E D R 18,27.
(425) 4
0-3
R 0 ENn DATE SIGNED OfE
771-0220 REL D BY
6 1 t�T
tU
aEW:g KT 1333 1 . 11J91z2_11
A !tTION j�te,41I)A111161-
TIL NAL - FILE - YELLOW - INSP CTOR
IT V FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE On GI
APPROVAI ORA CER IFI. PINK - OWNER - GOLD - ASSESSOR
A FINAL INSPECTION HAS BEEN MADE AND 109 GREEN - ACCOUNTING
uBC SECTION
ES
CATE OF OCCUPANCY HAS BEEN GRANTED.
PRESS HARD -YOU A KING 5 CO
04102
z
0
i
0
m
=i:q
6-4
am
c
ni 0
0
--lo
0 C
-4 C
MM
MZ
ic)
o -n
n
m m
055
0 r-
0 M
C ch
K co)
M 0
Z
.4
z
—4
X
55
z
9
0
m
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Si
ocaprvl.doc.l:tenip:bldg:fomlslO/01