20040163.pdfm
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DATE RECEIVED
PERMIT EXPIRES
ZONE PERMIT
CITY OF EDMOND7'
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
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OWNER E/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LID NO.
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MAILING ADDRESS LID FEE $
TIESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pam" 8'.k.
fi-60JE
Stsett UBe Partnit Raq'd
CITY P ZIP TELEPHONE EXISTING — PROPOSED Inspection Requited
Sidewalk Requited
REQUIRED DEDICATION— FT UnderWound
Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 13 NO 13
ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY Zl��]TELEPHONE ffif�� 9 4 LIL 1442 &k."
NAME CBL# %001
EERI VIEWED 8 DATE
A D D R 0"S 11 1 %A N;��Pmm
—BY
FIR9 REVIEWED DATE
CITY !2JE ONE
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION 1$ BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D POSTED
113YES
13NO
SEPA REVIEW SIGN AREA � HEIGHT
PROPERTY.TAX . ACCOUNT PARCEL NO COMPLETE PROPOSED., " ALLOWED SE13
EXEMPT ALLOWED PROPO
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,
IUV iEXP
LOT COVERAGE REQUIRED SETBACKS (Fr.)� PROPOSED SETBACKS (Fr.)
NEW a -RESIDENTIAL PLUMBING/MECH ALLOWED SIDE REAR FRONT�, UR SIDE REAR
PROPOSED FRONT
COMPLIANCE OR
ADDITION COMMERCIAL
13
CHANGE OF USE
PARKING LOTAREA [PLANNING REVIEWED'BY DATE
REMODEL [3 mummmy SIGN REO`D PROVIDED
REPAIR 0 GRADING FENCE I I I
CYDS
( /0' X j&LI Fr) REMARKS
DEMOLISH 13 TANK OTHER
oGARAGE -1 RETAININGWALL FIRE SPRINKLER
11 0
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESSWR ACTIV" EXPLAIN:
CHECKEDBY TYPE POONSTRUCTION ICODE OCCUPANT
AM-blJOVV"AL,
� GROUP
1 oV7 9.3—_
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NUMBER NUMBER OF CRITICAL c &V)
SPECIAL OCCUPANT
OF DWELLING AREAS INSPECTION
JAREA
STORIES UNITS NUMBER REQUIRED [:] YE LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
/* PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REG'D
VALUATION
U $
Description ..,,FEE Description FEE
PlanCheck
State Surcharge
HEAT SOURCE
hZING %
OT SLOPE % Buildi� Permit'
9
VESTED DATE Plumbing -
Mechanical
City Surcharge
PLAN CHECK NO:
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOIIIIAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMI[TAPPILICATION: 100DAYS
IL PERMIT IUMM I 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I
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
Landscapeinsp.
Total Amt. Due
&5
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Be
Receipt #
1
11 ak
I HEREBY ACKNOWLEDGE 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-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE W
PRK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Otficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OFTHE 1*8OR D OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMENIS. C~IQN INSU CE AND RCW 18.27.
OFFICIALS GN URE DATE
11 A E
"G7' IW
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DAT SIGNED/
T, ,
-
771-0220
.4 ____DATF_
RELEASED BY
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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-OWNEn GOLD -ASSESSOR
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