20030976.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
ZONE
�2�5 _09
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB #
ADDRESS:Zyo
L
OWNER NAME/NAME OF BUSINESS
�tllb
1_2)e)rCknj:A
PLAT NAME/SUBDIVISION NO. NO.
MAILING ADDRESS
LID FEE S
-7:110 dwc�K
IF51-F AV
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW
Street Use Permit Req'd
CITY ZIP ELEPHONE
T
EXISTING - PROPOSED- Inspection Requited
Sidewalk Required
LZ
H (0 S M
underground
REQUIRED DEDICATION- FT Wiringrequired 13
----7.
NAME
METER SIZE LINE SIZE OF FIXTURES PAV REQUIRED
YES 13 NO E3
z
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
z
CITY ZIP TELEPHONE
NAME CBLN
k1 Vr (7CA 01
ENGINEERING REVIEWED BY DATE
cc
ADDRESS
FIRE REVIEWED BY DATE
Id
cc
CITY ZIP TELE�HONE
9:
U
6 11 W)
VARIANCE OR CU SHORELINE ORAD1111 INSPECTION BOND
POSTED
STATE LACENSE NUMBER EXPIRATION DATE
REO'D
1$
��
[3YEs ONO
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
PR
BED OPOSED
COMPLETE EXEMPT ALLOWED PROPO ALLOWED
a-7 CLi I C' C 10
, , ,
EXP
4
NEW RESIDENTIAL PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN
REO'D I PROVIDED
REPAIR GRADING FENCE
0 CYDS X FT)
REMARKS
OTHER
0 DEMOLISH 13 TANK
IGARAGE o RETAINING WALL o FIRE SPRINKLER
3
CARPORT -ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY UCTION CODE OCCUPANnI
TYPE OF QtJSTR
GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLANG AREAS
SPECI ALINSPECTION OCCUPANT
STORIES UNITS NUMBER
JAREA
LOAD
REQUIRED
DESCRIBE WORk TO 13E DONE
REMARKS
PROGRESS INSPECT11ONS PER UBC 1081FINAL INSPECTION REG'D
AP�061 110'f�l
_s LAT-47-4
Ive 7VB�&,�
VALUATION
$
eSC"Pt'On
Description FEE FEE
'ta rge
I te Surcha
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
3 DORILAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
t:
Engr. Review
a
15 PERUffAPPUCATION: 150DAYS
-
PERMIT UMM 1 YEAR - PROVIDED WORK IS 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 Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp. Total Amt. DUB
!3 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
NOR LIMIT IN ANY WAY THE
Recording Fee Receipt #
I HEREBY ACK14OWLEDGE 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 until signed by the
CALL
I . fIN
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
VIOLATION 9f THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
uIlding Official or his/her Deputy: and Fees are paid, and
OR INSPECTION receipt is _,;knowiodged in space provided
WORKMEN'"91IJIPE,N�ffl��RANCE AND RCW 18.27.
W4
ICIA SIGNATU TE
SIGNAj!6A'(0V A DATE SIGNED
S11
(425,) i1AA
A"
771-022 T
R SED BY
A17tNTION
off 133
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U
L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFF ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIF-S GREFN - ACCOUNTING