20030992.pdfIM!
—1 LPERMITEXPI_____
DATE RECEIVED
USE PERMIT
CITY OF EDMONDS ZONE NUMBER 2,
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESZ
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OWNER NAW/�JSINESS V
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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CITY� ZIP ITELEPHONE
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NAME
ADDRESS
CITY
TELEPHONE
NAME
ca. —T,/VC
ADDRESS
STATE LICENSE NUMBER E]
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PROPUBTY TAX ACCOUNT PARCEL NO.
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
9YI`E OF USE, I
RESIDENTIAL
COMMERCIAL
muLnFAmiLy
GRADING CYDS
TANK
RETAININGWALL
ROCKERY
CBL #
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP
RW P@(Mft'RsV11V116d
Street Use Penh Req'd
EXISTING — PROPOSED
InspecWn Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wirklilrequired 13
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
[
YES 13 NO 13 15
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY
DATE W
ONE
—03 Or,
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
rION DATE
jCHECKED
I
REqD.,p
POSTED
13YFS
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$
SEPA REVIEW
SIGN AREA �
HEIGHT
V
COMPLETE E X EMP T
ALLOWED PROPOSED
ALLOWED PROPOSED
,
i��PLIJMBING/MECH
EXP
z
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
COMPLIANCE OR
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z
CHANGE OF USE
-
- PKRKING
LOT AREA
PLANNING REMVVIEWED BY EIATE
SIGN
REO'D
I PROVIDED
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FENCE
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( — X—FT)
REMARKS
0 OTHER
FIRE SPRINKLER
0 FIRE ALARM
NUFABER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER'�'I—Tnq
DESCRIBE WORK TO BE DONE I
4�
11dF
2000VC, -&jkt4 a1(&tC,*55ot
rd-146.t-L —0AAd Zr-Are5
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES 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.
PERMITAPPLICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WIT14IN IGO DAYS
SEE 13ACK 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 CITYS 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 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
WORKMEN;S4XW,PENSATION INSURANCE AND RCW 10.27.
"J� �WNE OR A7!t� D7jATE SIGPED
7
CHECKED BY UUUUrArJW
GROUP
SPECIAL INSPECTION JARItA occupAtJr
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
ao
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
7--
Landscapelnsp.
Total Amt. Due
WVAL
Recording Fee
Receipt #
CALL
FOR INSPECTION
1A9
025)
771- 22
APPLICATION APPR
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Face are paid, and
receipt Is acknovviocigod In space provided.
FFICIALS SIGNATURE DAT
761-
RELEASED BY E
1
ATTENTION - \?" M �" __V4 I&
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U C C=A%1q/P.
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF - ORIGINAL -FILE YELLOW- INSACTOW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COP159 GREEN - ACCOUNTING
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.RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:tmV:bldg:fomis:ocaprvl 3/25/04