20030901.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY
NAME
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CITY
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ZIP I TELEPHONE
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ZIP ITELEPHONE
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CITY ZIP
LICENSE NUMBER
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P
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USE PERMIT —7
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NUMBER
JOB
ADDRESS
PLAT NAME/SUBDIVISION
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESC Approved
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RW P1GPrM:1PR.q!u11G.d
S".. 'Ise Permit Req'd
EXISTING — PROPOSED
Inspection Required 11
Sidewalk Required 0
REQUIRED DEDICATION— FT
Und&rW&.xW
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES13 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
1 11
I ENGINEERING REVIEWED
DATE
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EXPIRATION DATE VARIANCE OR CU SHORELINE 08 ADEIN INSPEC I TION BOND
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
0 RESIDENTIAL
0 ADDITION
)9�__COMMERCiAL
15<REMODEL
MULTIFAMILY
0 REPAIR
GRADING CYDS
0 DEMOLISH
TANK
IGARAGE
3 CARPORT
RETAINING WALL
ROCKERY
(TYP.E OF USE, BUSINESS OR ACTIVITV EXPLAIN:
Y.
NUMBER
OF
N M ER OF
DWELLING
STORIES
UNITS 't�r
DESCRIBE WORK TO BE DONE
1[3 REG D $
YES ORD I
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
EXP V_ 1 1 W4
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1:1 PLUMBING / MECH
ALLOWED PROPOSED FRONT SIDE REAR
FRONT LIRSIDE REAR
COMPLIANCE OR
1:1
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REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG-D
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Description FEE Description FEE
Plan Check
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State Surcharge
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VESTED DYE Plumbing
Mechanical
City Surcharge
PLAN C096K NO-
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CUR13S, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: IGO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 15 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
11��D
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
SYT
IHEREBY DGE VE EAD THIS APPLICATION; THAT THE INFORMATION
TTHHAATAHAAM
APPLICATION
I I
GIVEN I REC ANCI THIE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPROVALff
IAE R WITH CI
THE 0 ER AG E TO C L TY AND STATE LAWS REGULATING CONSTRUC-
CALL
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This application 15 not a permit nlil signed bythb-
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TION; GIN H ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or histher Deputy; and Fees are paid, and
IN VIO E 0 E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORK 0 NCE AND RCW 18.27.
OF NAT DA
S41GNfjUtA E
DATE SIGNED
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771-0220
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EXT 1333
NELEASE /`
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/ , 7) 77JB,/�,9
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I t /A T/W/f/Ly/1 /.6/
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORI INAL- ILE YE1OW-Il(SPECTC
)t��REEN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 NK-O ER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES ACCOUNTING
FINAL PROJECT APPROVAL FORM
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:temp:bldg:fomis:ocaprvl 3/25/04
ATE RECEIVED-o
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY ZIP ITELEPHONE
NAME
CITY
NAW
ADDRESS _71i
I
7
CITY
SJA%LICENSE NUMBER
,MtA-,- i 1* 44,
WP. vst3z�
ZIP ITELEPHOIN
ZIP TELEPHONE
0,26 1 -4w. ,
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
��COMMERCIAL
'12(REMODEL
FAULTIFAMIIY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
o RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESS OR A LAIN:
NUM13ER
OF
NUMBER OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
CBL A
Wal
a 0
PLUM13ING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBgW
JOB
ADDRESS2,3/5
�UIMAPIT
A)
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE5 Approved
RW EP;ernTM Required
Street use Pemit Req`d
EXISTING — PROPOSED
ln$W— Required
Sidewalk Required
.REQUI . RED DEDICATION- Fr
UnderWound
Withng required
METER SIZE
LINE SliTO.
OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPON SIBLE FOR EROSION CONTROWDRAINAGE
FIRE REVIEWED BY
DATE 1
/ — 2. C) �_ 0�p IE
VARIANCE OR CU
-
SHORELINE OR ADD#
I INSPECTION
REO'D
I BOND
POSTED
E3YEs
$
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
:XP_
1 "00-
, W4
-
"C-
,
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT LIRSIDE REAR
N 41
Ive,
PARKING
RECrD PROVIDED, I
LOT AF IEA
PLANNING REVIEWED BY DATE
I
_7
CHECKE13 BY ITYPE RUCTION ODE OCCUPANT
-5P42 GROUP
CRITICAL 'JARE 4 act7 OCCUPANT
AREAS SPECIAL INSPECTION A LOAD 2 5---
NUMBER MA REQUIRED [] YES
REMARKS
1PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION RECtD 2i
VESTED
$
A
Description FEE Description' FEE
Plan Check state Surcharge
% Building Permit City Surcharge
Plumbing
Z YEE
L;/ 2: �2 L
__-L
Mechanical
THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I=
BE DONE ON PRIVATE PROPERTY OHLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CUPAS, SIDEWALKS, DRMVAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
15
PERUrTAPPUCATIOW. 11118DAYS
CL
PERMIT ILIMM I YEM - PROVIDED WORK IS STARTEEI WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMTT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF 141S OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit,
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ZIP
Receipt #
ALL CLAIMS rOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NO' r BE
Landscapainsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
NOR LIMIT IN ANY WAY THE CITYS
Record
Receipt #
I HER By EDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
'AT
APPLICATION
APPROVAL�3,
GIV E . AND In A IAM THE OWNER, On THE DULY AUTHORIZED AGENT OF
THE R I AG E TO CGM Ly WITH CITY AND STATE LAWS REGULATING CONSTRUC-
' M
CALL
This application Is not a permh unt" sinned by thd
H ; I POJN TH4 WO ORIZED THEREBY. NO PERSON WILL BE EMPLOYED
T 3?
IN 1 1 1131: E I*BO ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or hiliftier Deputy: and Fees we paid, and
receipt Is acknowledged in spaco provided.
E , SATN I "CE AND RCW 18.27.
0 4NAT DA,/T
SlGlhlt�E 4p�%
DATE SIGNED
IA13
11425)
, �E� _
�7,3) .2
hVi
Au
/0. Y,
77 -11 -n*31
Real
RELEASE 0 1 f V, i
S 7)611,11A"
ATT0010IN EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BU &DIN OPTRICT UNTIL - 0 1 / V 6' 1, Ll
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR 0 1 INAL - ILE YdO, N - 14SPECT _'
Of14
0
NK- ER GOLD - ASSESSOR PH
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 10 is REEN - ACffCUNTINrr �[)t 1
04/02 PRESS HARD -YOU AJA &&?16 5 COPIES q