20030948.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY
NAME
ADDRESS
CITY ZIP TELEPHONE
PERMIT EXPIR
USE PERMIT
ZONE NUMBER
JOB - -7 p I LJ SUITE/APT#
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ADDRESS 160,�z �
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
TAODDRE
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P UBLIC
TIES AP
RW cap(m=641
Street Use Peffnit Req'd
EXISTING - PROPOSED
Inspection Required
Sidewalk Required
EQUIRED DEDICATION- FT
R QUI ED
Underwound
WWng required
M T R SI
METER SIZE
LINE SIZ�
OF FIXTURES
PRV REQUIRED
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NAME CBL #
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STATE LICENSE NUMBER
EXPIRATION DATE BY
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PROPERTY JAX ACCOUNT PARCEL NO.
0060 1
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1:1 NEW
)%,RESIDENTIAL
PLUMBING I MECH
1:1 ADDITION COMMERCIAL
COMPLIANCE OR
1:1 CHANGE OF USE
1:1 REMODEL 0 MULTIFAMILY
11 SIGN
1:1 REPAIR GRADING [3 FENCE
CYDS X FT)
0 DEMOLISH TANK
OTHER
— GARAGE RETAININGWALL FIRE SPRINKLER
1-1 CARPORT ROCKERY FIRE ALARM
(TYPE OF U OR ACTIVITY) EXPLAIN:
BE, BQINESS
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NUMBER NUMBER OF
OF DWELLING
CRITICAL
AREAS
STORIES UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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K NO:
VESTED DATE
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMFTAPPLICATION: 180 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
1APPLICAUL 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 C17YS 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 AGREE TO 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'S COMPENSATION IIASUBANCE AND RCW 18,27.
1 63
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING
BY
DATE
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
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FRONT URSIDE REAR
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I PLANNING REVIEWED BY DATE
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REQ'D I PROVIDED
CHECKED BY ITYPE 1111M CCQE OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED[3YES LOAD
REMARKS
111P'ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
F re Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPEC
(425)
771-02,'
EXT 13
FEE
Description
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # !
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
BY
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UM41_��
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
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DATE RECEIVED PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS -7 P
OVNNAM91NAME OF BUSINE S
f .1 LOT NO. LID NO.
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NAME
ADDRESS
CITY ZIP ITELEPHONE
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCIR Approved
Rw Pernot Required
SUM Use Parmit Raced
EXISTING — PROPOSED
Inspection Requited
Sidewalk Required
REQUIRED DEDICATION— FT
Unda;WmM
Wiring required 13
IMETER SIZE
LINE Sl"
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NO. OF FIXTURES
PRV REQUIRED
ES C3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR
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ENGINEERING REVIEWED
BY DATE
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STATE LICENSE NUMBER EXPIRffION DATE I BY
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SEPA REVIEW
SIGN AREA HEIGHT
PROPERTYr ACCOUNT-YARCEL NO.
� 1 4000
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
'05( t��60
X
EXP
0 NEW Ig'RESIDENTIAL LUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMPLIANCE OR
ADDITION [j COMMERCIAL 0 CHANGE OF USE
0 *REMODEL muLnFAmiLy SIGN
PARKING
REQ`D PROVIDED
LOT AREA PLANNING REVIEWED BY DATE
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1:1 REPAIR 0 GRADING cYDs FENCE X
FT)
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REMARKS
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OTHER
DEMOLISH TANK
0 GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BuAIN SS OR ACTlVrM EXPLAIN:
5
CHECKED BY OCCUPANT
0
FK
]TYPE
GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPE
SPECIAL IN CTION
OCCUPANT
STORIES UNITS NUMBER
REQUIRED 0 YES
JAREA LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER LIBC I 08/FINAL INSPECTION REG'D
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VALUATION
$-3 97 L-t
Description
FEE
Description
FEE
(5��
Plan Check
State Surcharge
—No
NEAT SCJURCE GLAZING % LOT SLOPE %
0 4t )
Building Permit
City Surcharge
PLAIII CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORRES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: 13E DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CUR=, SIDEWALKS, DRIIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATIION: 180DAV8
PERMIT UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
i .�. 1. 1 11
PlanChk.Deposft
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"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCOSORS: Tire Review.
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
Total Amt. Due
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Receipt N
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording �e�.:
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I HEREBY ACKNOWLEDGE THAT I HAVE R M- THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORREVP AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP1Y WITH CITY AND STATE LAWS REGULATING CONSTRUC- ALL This applicallon Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Oftiall or his/hot Deputy: and Fees are paid, and
IN Viol ATION OF TUC BOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTI receipt Is acknowledged In space provided.
WORKMENS COMPENSA
_!!��JCE AND RCW 18.27.
SIGNATUP (OWNE AGE, Z� FS19NED V-04a)
tj I DA513 163 E.
M-0220 ELEAS
ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U
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 COPIES
0 E >
BY rA
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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