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DATE RECEIVED
Le� 3 1 PERMIT EXPIRES
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CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
ZigirNAME7E O7F*9INESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
MJING AD,*CSS TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pamift Require
-:2200,/ . � C, Street Uge PdrMft:daq'd
C TY EXISTING — PROPOSED Inspection Required
ZIP TELEPHONE Sidewalk Required
REQUIRED DEDICATION— FT underground
A Whing required 13
'NAME METER SIZE LINE SIZE i NO. OF FIXTURES PRV REQUIRED
YES13 NO 13 z
ADDREbSo REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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TrA-M LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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M-150M
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13 NU M_BEh I NUMBER OF/ A' A CRITICAL
OF DWELLING AREAS
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DESOMBE,WORk TO Bt DONE A A
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HEAT SOURCE GLAZING % LOT SLOPE %
PLANCHECKNO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOUJUN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICATION: IGODAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAK ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
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
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
ilIGNATUFP (OWNER �f �GE DATE SIGNE7
FIRE REVIEWED BY DATE W
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VARIANCE OR CU1__r1R.ELlNE
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FRONT LIRSIDE REAR
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DATE
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CHECKED BY ITYPW C &TION co0iij _ OCCUPANT
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SPECIAL INSPECT16N AAEK OCCUPANT
REQUIRED [3YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
P.1-7
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. D Ue.
Recording Fee
Receipt #
L11 �<5�
CALL
FOR INSPECTION
(425)
771 -0220
EXT 1333
APPLICATION APPROVAL
This application is not a permit until signed by the d
Building otticial or his/her Deputy: and Fees arc paid. an
receipt Is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
REWSED BY IDAYE
Alk" A A 1 A YA /h JA.0
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1-,' .4 =JCfW4aA;FI /
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - I'N'SP06TO
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 RE6EIVED, PERMIT EXPIRES
MONSOON
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITFJAPT#
ADDRESS
NAMEIWE OF ISINESS -7 4,gg
9,_ L d AAT NAME/SUBDIVISION NO. LOT NO. LID NO
077 ZLC - - ------
I M11ING ADSS LID FEE $
1 7ESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pernift RequIrw
Street Use Permit R@qV
Inspectio Required
CITY p TELEPHONE SidewalknRequired
ZI EXISTING PROPOSED
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A
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FELEPHONE
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VV
.AAME METER SIZE LINE SIZE F NO. OF FIXTURES PRV REQUIRED
YES13 NO 13
ADDRE680 REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
U OL
aL -;Zt 300
CITY 2:1 ITELEPHONE
AAME ICBLN
ENGINEERING REVIEWED BY DATE
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TELEPHONE
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10 VARIANCE OR CLI SHORELINE OR ADB# INSPECTION BOND
LICENSE NUMBER EXPIRATION D TE CKE �B REO'D POSTED
I 10YEs IVNo s ...... wl"
to Lab a 3 Pit? Z2 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
M
5 6:&7.600n EXP rn
0, LOT COVERAGE REQUI D SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) -4
NEW RESIDENTIAL MleLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFISIDE REAR 02
ADDITION MERCIAL o COMPLIANCE OR
m4rm CHANCE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE M
00R'*E`MODEL muLnFAmiLy I Is.
SIGN REO-0 I PROVIDED i
-2
0. REPAIR [3 GRADING FENCE
x FT) REMA
%
OTHER
DEMOLISH [3 TANK 0
0 _n
GARAGE RETAINING WALL FIRE SPRINKLER
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INESS OR A
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NUfABEh I NUMBER 05VP CRITICAL
I I NUMBER
DWELLING AREAS SPECIAL INSPECTION OCCUPANT
10.�. LOAD
OF mr, YES 0
STORIES UNITS REQUIRED C
DONE
M viow 14� REMARKS M 0
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REaD
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VALUATION
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Description EFEEE Description FEE z
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Plan Check State Surcharge =1
0
HEAT SOURCE T_ GLAZING % LOT SLOPE % Building Permit City Surcharge Z6 M
PLAN CHECK NO: VESTED DATE Plumbing C�_
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORIKNOTED. THIS PERMIT COVER
3 WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERIIAWON.
Engr. Review
PERMIT APPLICATION: lea BAYS
PERMIT UMn' I YEAR - PROVIDED WORK IS STARTED WITHIN 11110 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF.Of HIS OR HEN SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN NTEREST, 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 Total Amt. Due',.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp.
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee
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- This application Is not a permit untH signed by the'
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL BuUdinQ OMeW or his/her Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknovAodged In space provided.
WORKMERS COMPENSATION INSURANCE AND RCW 18.27.
we OFFICIALS SIGNATURE DATE
SIGNATU (OWNER AG DATE SIGN IA13
S-VAM
M
771-0220 1 RQAASED By 'DAfE
ATTENTOR Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURg UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSP56OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES