20040216.pdfL LOATI IC111111
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER
INSTRUCTION PERMIT APPLICATION
JOB
ADOIE11 _
h"
7 SUITEIAPT#
/ � /I —
A NAM� E EIII.SINESS
PLAT NAMEISUBOIVISION NO.
I LOT NO-
LID NO.
LID FEE S
�01
,LING ADDRESS f
PUBLIC RIGHT OF WAY PER 11111CIAL STREET MAP
EXISTING — PROPOSED—
SM ... N
CITY ZIP
JTILIIHONE
REQUIRED DEDICATION—
FT —
13
METER SIZE
LINE SIZE
.0. OF FIXTURES
RE Ul
I
1
YEPRV
S C3 No El
REMARKS
NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAtNAGS
NAME
bI
ADDRESS
CITY zip
IT11EPHON
NAME 71L
__*
AIOIEll
CITY Z11
TELEPHONE
STATE LICENSE NUMBER E111141ION
PROPERTY TAX AGO UNT PARCEL NO.
NEW ESIDENTAL 0 PLUMBING/MECH
COMM PC' C MPUANCEOF
ADDITION OMMEACIAL M
CHANGE OF USE
REMODEt MULTIFAMILY SIGN
ri FENCE
REPAIR rl GRADING CYOS x
DEMOLISH TANK _t�,OTHIR
oGARAGE RETAINING WALL F ESPRINKLIER
M
0 4RPORT ROOKERY RE ALARM
(TYPE OF USE, BUSINESS 0, " EXPLAIN:
f-77
NUMBER
0
"U1 11 OF
D ELLING
I I
C RIT104L
AREAS
S, _
TORIES
UNITS
NUMBER(14
DESCRIBE WORK TO BE DONE
'17
IF
HEAT SOURCE GLAI,Nt�,f�
LOT SLOPE
PLAN CHECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BEDONEONPRIV E PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
2� DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
PE MIT APPUC=- hills 4ii
PERMIT LIMIT. I YEAR - PROVIDED W RK IS STARTED WITHIN 100 DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BERAL OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, IT' OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
91 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
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APP ICATION; THAT THE INFORMATION
GIVEN IS DO RECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
RI
THE OWNER. AGREE TO CO PLY WITH CITY AND STATE LAWS REGU ING COMSTRUC.
TION; AND IN DOING THE WORK AUTH RIZED THEREBY, NO PERSON WILL BE EMPLOYED
VIOLATIO 0 TH LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WO K ENS P SATION 17SURANCE AND RCW 10.27.
[IN
A
DA..j
SIGNATU:ZR�R
'BE REVIEWED BY DATE
VARIANCE OR CU I SHORELINE 02 All' I INSPECTION BOND
RE '0 POSTED
C3YES ONO
SEPA REVIEW SIGN AREA HEIGHT
:OMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED I P13OPOSED
IF I
LOT COVERAGE REQUIRED SETBACKS IFT) PROPOSED SETBACKS (FT)
LLOWED PROPOSED FRONT SIDE REAR FRONT UR St a REAR
PARKING I LOT ARFA PLANNING REVIEWED BY DATE
ISO. I PROVIDED
I.- =
NECKED BY ITYPE !fUSTRUCTION I CODE 1 00 UPANT
LaI q -7 1 GROUP
!PECIALINSPE-ION JAREA
tBOUREO r] LOAD
YES 100
PER UBC I OS/FiNAL INSPECTION REOM
W 7
$
F
Description
FEE
Description
FEE
Plan Check
State Surcharge
Lu"I I'd I IT g P. r it
City Surcharge
1�5_
Plumbing
Base Fee
Mechanical
Grading
Ertgl� Pvl_
Engr. Inspection
lsf�e Review
PlanChk. Deposit
Fire Inspection
Receipt If
Landscape Insp.
Total Amt. Due
el-145
Recording Fee
Receipt At
12:—.
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This OPPIKatiOn Is not a P0111-111 slgrsd by th.
idd
.IpiIkn-I.d9.dIP ... Pls
OFFICIALS SIGNATURE
RELEASED SY T
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- OR GINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK-OWNEA GOLD -ASSESSOR
z
9 i,
0
C:
MO
8100
C
M in
z
j0-4
z
0
in
-4
= m m
0
001
M 0
z
;U
z
ca
z
9
0