20030933.pdf4
DATE RECEIVED
4
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O� �EA NAME/NAME OF BUSINESS
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MAILING ADDRESS
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NAME
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO. if
00-1--7 6 :5 -0 00 0 - 0 00
0 NEW
Ea0000RESIDENTIAL
0 PLUMBING / MECH
G�rADDITION
0 COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
0 REMODEL
'0 muLnFAmiLy
0 SIGN
0 REPAIR
GRADING
0 CYDS
o FENCE
( _ X_FF)
0 DEMOLISH
0 TANK
0 OTHER
0 GARAGE
CARPORT
o RETAINING WALL
ROCKERY
0 FIRE SPRINKLER
FIRE ALARM
9= OF USE, BUSINESS OR ACTIVTM EXPLAIN:
NUMBER
NUMBER OF
CRITICAL `1 &541110N
OF
DWELLING
AREAS
.STORIES
UNITS
9
NUMBERAS -a.
DESC?4YORK TO BE DONE
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PLAN CHECM VESTED DATE
THIS PERMIT AUTHORCM8 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL RCQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFX 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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY 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 AGREETO COMPLY WITH CITY 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
WORKMEN`8 COMEENSATION INSURANCE AND RCW 18.27. A
DATE
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USE
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PERMIT EXPIRESE,:2-:: 1 -0
PERMIT
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NUMBERS M3,
SUITE/APT#
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PLAT NAME/SUBDIVISION NO.__
LOT No
LID NO.
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
RW Pannit Required
I-* Peffnit Raq'd
EXISTING — PROPOSED—
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF,FIXTURES
PR V REQUIRED
I
YES 13 NO 0 z
I
REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
I
FIRE REVIEWED BY
BY DATE
DATE I -.
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REO'D
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POSTED
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-
13YES EKO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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0
25# 1 24.7'
.XP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
25 %
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
RE0`D PROVIDED
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REMARKS
CHECKED BY I TYPE OF f.OXSTRUICnON CO OCCUPANT.
1117- GROUP )
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES A 0 LOAD
IREMARKS I
1PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0 H-3
R
DescrIpIlon
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
/1" CALL
FOR INSPE(
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771-02,'
A'17TENTION I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
, I�L�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 C
F kEE: Description FEE
State Surcharge
City Surcharge
-1
Plan Chk. Deposit I Gf6 ,
Receipt # A4 /,:P
TotalAmt.Due 4�m,
Receipt N 102E
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees aie paid, and
receipt Is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
ORIGINAL - FILE YELLOW - INSIfECT(5
PINK - OWNER GOLD - ASSESSOR
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16742 72ND AVE W --- EDMONDS, WA 98026
Parcel Legal Descripfion
SMO BLK 000 D-00 - LOT 6 LESS FDT BEG MOST SLY COR SD LOT TH N45*47
41W ALG SWLY LN 65 FT TH N63 *29 28E 131.36 FT TO INT SELY LN 125.86FT
TO POB & LESS BEG AT MOST SLY COR SD LOT 6 TH N45*47 41W ALG SWLY
IN OF LOT 6 345.17FT TH N79* 10 23E 52.59FT TH S34*41 37E 153.22FT TH
N69*103IE12FTTHS37*0436EI00.1 TTHN63*2928E121.1FTTOMSELY
LN LOT 6 TH S34*19 57W ALG SD SELY LN 125.86FT TO POB
5EWND FL
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