20040115.pdfI
DATE RECEIVED
P ERMIT EXPIRES
�LL
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE
ZONE PERMIT
6&_ NUMBERAw-
JOB SUITE/APT#
ADDRESS/.7
OWNER NAMENAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
MAILING ADDRESS
q V'r .5-4
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— Fr
METER SIZE LINE SIZE NO. OF FIXTURES
TESCPZP,IZV
RW P. " vs.
Street Use Permit Roq'd
Inspec-0on Required
Sidewalk Required Ell
Underground
Wiringroquired 13
PRV REQUIRED
YES13 NO [3
0
z
CITY ZIP TELEPHONE
9
NAME
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
f5
z
z
GAS PIPE TEST MUST BE
CITY ZIP
TELEPHONE
OBSERVED BY CITY INSPEC
NAME
MErr.41:�r,- a
--rA45-mi
. AFFIDAVITS SHALL NO1
ADDRESS
ENGINEERING REVIEWED BY
BE ACCEPI ED DATE
FIRE REVIEWED BY DATE
M
CITY ZIP
TELEPHONE
14 :2
STATE LICENSE NUM13ER EXPIRATION DATE,,.
6djf=zMA4Tv /,9'/(Qoq
VARIANCE OR CU
loolln
SHORELINE OR ADBO
10YES
I NSPECTION
REqD
_WO
BOND
POSTED
$
PROPE , TW.ACrC.9 NTPARC% 0
V6LJOq-7
SEPA REVIEW
COM PLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
. " - HEIGHT
-ALLOWED PROPOSED
00
EXP ,
;?o 4
/15 ,
z
NEW RESIDENTIAL 191 PLUMBING MECH
ADDITION COMMERCIAL
[3 COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY 1:1 SIGN
REPAIR GRADING FENCE
13 1 CYDS ( — X Fn
LOT COVERAGE
ALLOWED PROPOSED
Mo.-
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT L/RSIDE REAR
PARKIN
PLANNING REVIEWE I 11-'BY D
REMAR2t��p
DEMOLISH TANK OTHER
GARAGE RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY FIRE ALARM
Z)
OWE OF USE, BUSINESS kIN-
9 T%qx U,"--
CHECKED BY
ITYPE IMON
OCCUPA
GROU7/ '61
z
5
NUMBER
OF
STORIES 3
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
INSPEC*nON IIAREA.
REQUIRED [] YES
I
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE GAZA6ac f _PM
REMARKS
PROGRESS INSPECTIONS PER LIBC 1108/FINAL INSPECTION REO'D
7?nf—j�e �4j_ I A/ )RO. ;> e-
1 ki 6- > 4 bit -r-
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SS)URCE GLAZING % LOT SLOPE %
6ii104_5r_ I Building Permit City Surcharge
PLAN CHECK NO: / VESTED DATE Plumbf ho I .
U-177
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
echanical
It
a
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE P UBILIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
t:
SEPARATE PERMISSION.
2
M
PERMITAPPILICATION:
Engr. Review
IL
ISODAYS
PERMIT LJM[r 1 YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICAW 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
a
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
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
Landscapainsp.
Total Amt. Due
0
X
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
seassaaa
Recording Fee
Receipt #
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
APPLICATION
APPROVAL
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
CALL
This application is not a permit until signed by the
IN VIOLAT!ON OF THE L6SOU.CODE OF 3HE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged;n space provided.
WORKMEN S COMPIEN
,5ff5WW8V10CrND RCW 18.27.
SIGNAT AGE
1..�
DATE SIGNED
(4�25)
OFFICIALS SIGNATURE DATE
TIA
- 7-0
�
771-0220
410141
"OV�
mi
R SED BY DATE
ATTENTION "
EXr 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE YEILC 4CTOR_r
09/03
PINK - OWNER GOLD -ASSESSOR
PRESS HARD -YOU ARE
MAKING 4 COPIES
z
9
0
M