20030963.pdfSle vev- r ///a-/
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
[OWNER MEINAMELF BUSINESP
To.
- L4W ,
MAILING ADDRESS A -
TELEPHONE
NAME
ADDRESS
CITY . I - ZIP
NAME ICBL#
CITY ZIP 5,TELE 1*,E
I PH
qzc) tqx -)oo
ME XNSE NUMBER '-,XPrRA?fON 6ATE BY
411- jDt-VD-mrr7A.Af) -71,--,jW 1 M I
PROPERTY TAX ACCOUNT PARCEL NO.
0 NEW
0 RESIDENTIAL
;Mt��SIN MECH
0 ADDITION
COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
Z"REMODEL
0 MULTIFAMILY
0 SIGN
0 REPAIR
GRADING
0 CYDS
0 FENCE
I X FT)
DEMOLISH 0 TANK 0 OTHER
0 GARAGE RETAINING WALL F RE SPRINKLER
CARPORT 0 ROCKERY FIRE ALARM
(TYPE OF USE, WSINESSOR ACTIV"I~N:
I PERMIT EXPIRES IV[ r 11
USE PERMIT
ZONE I A 3
NUMBER ZU ()
JOB SUITE/APT#
ADDRESS--e
:�zo -4 ;ff.—:SUj 'zW
PLAT NAME/SUBDIVISION NO,
LOT NO.
L D NO.
L:13 FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP M
RW P4fZPR'0.V1Vd
Street Use Permit Req'd
EXISTING — PROPOSED
Inspectlo" Requited
SidwalkRequited
REQUIRED DEDICATION— FT
Underground
Whring required cl
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY DATE
NUWBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
I L
DESCRIBE WOAK TO BE DONE 11 1
FIRE REVIEWED BY DATE ul
VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BOND
REO'D POSTED
SEPA REVIEW SIGN AREA 13YEs I ONO $ HEIGHT —
COMPLETE . EXEMPT ALLOWED . PROPOSED ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA I PLANNING REVIEWED 13Y DATE
REQ`D I PROVIDED I
CHECKE13 By IM CO TRUCTION CODE OCCUPANT
zhir— GROUP _6_
SPECIAL INSPECTICiN AREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1100/FINAL INSPECTION REG'D
1
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORLEES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 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 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 PERMrf. 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 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 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
WORKMEI'VS COMPEN=URANCE AND RCW 18.27.
SIGNATURE (OWNER Ca4GENIJ I DATE SIGNED
$ r
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
1477)
Plumbing
&
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt N
CALL
FOR INSPECTION
IA05)
%-Wa-
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Otocial or histher Deputy: and Fees are paid. and
receipt 13 acknowledged In space provided.
OF ATE
"Am "zp4lo-z
DAT
ATTENTIOPY EXT 1 3
1,4 ILI?
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR�GINA' FILE YELLQ/ - 'INSACTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING