20030890.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
LPERMIT EXPIRES
USE PERMIT
ZONE
NUMBER Z*/v -
JOB
ADDRESS Zj
SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
LOT No.
LID NO.
rLID FEE $
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
RW Patft Required
Street Use Permit Rsqd
CITY
ZIP
ELEPHONE(P,,,,,.,,,
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
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REQUIRED DEDICATION— FT
Underground
Wiring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I YES 13 NO
ADDRESS
REMARKS
OWNER/CO&TRAM!LM j2VaLWjgg=WL/,DRAINAGE
1 ODKI0
CITY
ZIP TELEPHONE
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PROPERTY LINE
NAME
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ADDRESS
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FIRE REVIEWEDSYES DATE
DEMOLITION INSPBC170H
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CITY
ZIP TELEPHONE
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VARIANCi-o—R-Crult a U Ift BOND
STATE LICENSE NUMBER
EXPIRATION DATE CHECKE BY
REO'D POSTED
13YEs
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO,
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
NEW
RESIDENTIAL
13 PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT URSIDE REAR
ALLOWED PROPOSED
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED 13Y DATE
REMODEL
MULTIFAMILY
SIGN
REQ`D I PROVIDED
0 REPAIR
[3 GRADING
CYDS
FENCE X
( — FT)
REMARKS
M71 DEMOLISH
1151111.
TANK
OTHER
—
GARAGE
RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
ME OF USE. BUSINESsr
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CHECKED BY N
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GRO
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NUM ID
OF
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CRITICAL ffi/ J
AREAS 03 _fz�7
4 AREA OCCUPANT
LOAD
STO IES
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NUMBER
REQUIRED [] YE,-
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC log/FINAL INSPECTION REGID
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VALUATION
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$
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Description
FEE
Description
FEE
Plan Check
S
f tate Surcharge
HEAT SOURCE
LAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERUrr AU`THORrZES ONLY THE WORK NOTED. THIS PERMrt COVERS WORK TO
t HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13UC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PFRMITAPPILICATION: IGO DAYS
06 PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
I'APPLICANT.
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
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Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CRYS 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, ORTHE 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building official or histher Deputy: and Fe as are paid, and
receipt Is acknowledged In space provided.
WORKMEN'S CO ION INSURANCE AND RCW 16.27.
OFFI IGNjirTURE TE
SIGNAT�UR
N GE"
DATE SIGNED
(4-25)
A
=60" 0
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am
771-0220
RELEASED BY DATt
EXT 1333
IT IS UNLArUL 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
JECT APP.R �VALF
TO:
DATE:
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DATE RECEIVED
Ll.)ATE
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS Z
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_
OW`Ni� NAMEMME OF BUSINESS
kftPLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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X)t3
MAILING ADDRESS LID FEE 111
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PUBLIC RIG4 OF WAY PER OFFICIAL STREET MA RW=-
Rsq�d
Su*M Use flarmil
CITY ZIP JTELEPHONIE EXISTING — PROPOSED mapsedon pAqtdw
Sid&wa* Required
%xi REQUIRED DEDICATION— FT I Underground
4be-kMilla WMgTsq_ 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES - PRV REQUIRED
I YES13 NO 13
I
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
0 PRB-INSPECTION REQUIRED
CITY ZIP TELEPHONE 0 SWEET TO BE CLEANED OF DEBRIS
NAME CBL# 0 SIDE SBWMt MUST 813 CAPPED AT
I ENGINEER I NG RfARFAW UNB DATE
ADDRESS MMU TO 98 REMOVED OR
VY AIM
FIRE REVIEWEIleff?� DATE
CITY ZIP TELEPHONE 4, DVW At AppRom Dump sm omw
VARIANCE OR C68B I BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY DMDMIWW4 STED
CHE*KUST ON B
UAC SMM k�
_112 10579AW -
SEPA REVIF#W U HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
, , ,
EXP
1:1 RESIDENTIAL PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
J:3 ;NEW ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
3 ADDMON COMMERCIAL COMPLIANCE OR
1:1 0 CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL [3, MULTIFAMILY SIGN RE PROVIDED
'FENCE
REPAIR GRADING CYDS X FI) REMARKS
IR DEMOLISH [3 TANK
GARAGE RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF USE. BUSINESS OR A
CHECKED BY occupr
ITYPE=eN
14 GROU
NUMBER, NUMBER OF CRITICAL W Jj A OCCUPANT
DWELLING AREAS - SPECIAL INSPECTION JARE LOAD
V,
'OF
STORIES UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER U13C 108/FINAL INSPECTION RECtO
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3
V-1 11111
lull N I
CW
VALUAMION I M kv
$
18 h V I zwo Description
FEE
Desciription
FEE
Plan Check
State Surcharge
HEAT SOURCE 76 LAZING % LOT SLOPE % Building Permit
City Surcharge
VESTED DATE
PLAN CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORDS8 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
BE DONE ON PRIVATE PROPEITTY ONLX ANY COMMUCTION ON THE PUBLIC
Grading
2
DO&IIAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPUCATIOW. ISO DAYS
PLqUIT IUMM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK POWIT 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
I
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
I spectl
Fire n on
Receipt # ,
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
.
—
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS 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 CORRECI` 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 porrrgt untU signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
Building Official or hlsftw Do": and Fees ore paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATINGTO
FOR INSPECTION
receipt Is acknovdofted In space provided.
WORKMEWS C�VVMN�ATION INSURANCE AND RCW 18.27.
OFFICIALS PIG"TURE D
SIGNATUR ER 0 64E"
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2
771-0'20
_01'�'
RELEASED DATt
ATTEN
Off 1333
IT IS UN L TO USE OR OCCUPY A BUILDING OR STRUCTURE 6NTIL�
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 L�
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
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