20030889.pdfm
DATE RECEIVED
Mill
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
C_ I kj!� L) 1- 9 r c- Le-S
MAILING ADDF&SS
16— C) Is— A74 &T 7—a 3-
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP I TELEPHONE
[PERMIT EXPIRES
L15EECJ6� PERMIT
ZON NUMBERA
JOB SUITFIAPTN
ADDRESS z-2-s—il 9 7
PLAT NAME/SUBDIVISION NO.
tOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW PormN Required
Street use Pairrill Req'd
EXISTING - PROPOSED
Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION- FT
Underground
Whing required 13
METER SIZE
LINE SIZE
0. OF FIXTURES
PRV REQUIRED
[
YES 13 NO C3 3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
NAME
Seirr)l
/
ENGINEERING
ADDRESS
)p O� 1DX
FIRE REVIEWED BY
CITY
ZIP
TELEPHONE
z -VjAbV 1-6/0 a b
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SIATE LICENSE NUMBER
EXPIRATION DATE CHECKED BY
VARIANCE 0 R CU
ge-frg &c.2
741/-'1
SEPA REVIEW
DROPERTY TAW ACCOUNT
PARCEL NO.
COMPLETE
E7
7- 7 0 Lf 7-1
0 o 3� 0 7
"to 0
I
EXP
j;3"NEW
0 RESIDENTIAL
[D PLUMBING/MECH
LOT COVERAGE
ALLOWED PROPOSED
COMPLIANCE OR
MeA
0 ADDITION
OMMERCIAL
0
CHANGE OF USE
..edc
0 REMODEL
0 APARTMENT
101"SION
PARKING
REO'D P OVID
DW
0 REPAIR
0 GRADING [:] FENCE
I - CYDS ( - X - FT)
REM,4jKk Lif
[3 DEMOLISH
0 TANK
OTHER
o GARAGE
CARPORT
PIMNING WALL 0 RENEWAL
0 R ERY
REVIEWED/DATE
DATE W
Ix
M
ELINE OR ADS#
a_.. — A—
SIGN
IEQUIFrED SETBACKS Fr.)
FRONT SIDE REAR
AREA I rLANNING REVIEV
INSPECTION I BOND
REO'D IPOSTED
L4ES E3 NO 1.
PROPOSED SETBACKS (FT.)
FRONT �.,L/R SIDE REAR
DATE
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CONSTRUCTION COD OCCUPANT
GROUP
NUMBER C' R
C
OF DWELLING IVI* -FAREAS SPECIAL INSPECTOR JAREA OCCUPANT
I NUMBER OF ITICAL
STO IES UNITS NIUMBER REQUIRED 0 YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION
Aj�&./& LC 0 9-A 0 -f- 4.1
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN C VESTED DATE
HECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFIL
:21 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
ISTMr"R H G
PERMIT APPLICATION: 180 DAYS
V
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 E DMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
2 /ALL
INSPECTION FEE
CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
p FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITYTO ENFORCE ANYORDINANCE PROVISION.'
REC
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
_CQ
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 Official or h15ther 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.
ORKMEN' COMPENSATION INSURANCE AND RCW 18.27.
ORKI
0 TURE DATE
SIGNATURE (OWNER OB41ENbill DATEjIGNED
I
OF'
L
(425)
/Ms /_1
Z�
771-0220
_e�
BY
ly DATC
ATTENTION
EXT/333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW- INSPICTOf
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 10
PINK -OWNER - GOLD -ASSESSOR
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