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PERMIT
DATE RECEIVED it/to
EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER/&Zt-/ 6 Zrr,>2—
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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NAMEINAME OF 13USI
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PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
MAILING ADDRESS
LID FEE $
TIESCP Approved
0 77.?
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
CITY ZIP TELEPHON
Street Use Permit Reqd
EXISTING — PROPOSED Inspection Required
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Sidiewalk Required
REQUIRED DEDICATION— FT Undo d
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NAME
METER SIZE LINE S��j NO. OF FIXTURES PRV REQUIRED
YES C3 NO 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STATE LICENSE NUMBER EXPIRATIO CHECK I ED BY
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REO'D POSTED
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NEW 12--R—ESIDENTIAL PLUM3,ING MECH
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REMARKS
DEMOLISH 0 TANK
GARAGE RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY F:REAIARM
(TYPE OF USE. BUSINESS OR ACTIVP
1f:5 CHECKED BY ITYPEjOF CQNS OCCUPANT
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NUMBER NUMBER OF CRITICAL
OF
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TORIES UNITS NUMBER y —
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SPECIAL INSPECTION AREA OCCUPANT
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REQUIRED LOAD
13YE
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D
VALUATION
$
Description -fEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
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Building
Permit
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City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRrVATE PROPEfTrY ONLM ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: ISODAYS
PERMIT ILIMM 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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection Receipt N
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
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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Recording Fee Receipt # 2M.L_.�
1 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
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
This application Is not a permit until signed by the
CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Foos are paid, and
FOR INSPECTION receipt Is acknowledged in space
WORKMEN'SotMP"SATION INSURANCE AND RCW 18.27.
provided.
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RELEASED BY D E
ATTENTION
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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 YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM
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CITY OF EDMONDS
USE PERMIT I
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS 2o-7 - tlZWle v 6/(�
OWNER NAMIUNAME OF BUSINE
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Perm Rawked
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street US: Permit fteq�d
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REMARKS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR cu SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
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SEPA REVIEW SIGN AREA HEIGHT
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REMARKS
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TYPE OF CO STRUCTION CODE OCCUPANT
CHECKED BY Z
GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION OCCUPANT
STORIES UNITS NUMBER
JAREA
LOAD
REQUIRED YES
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DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC,108/FINAL INSPECTION RECtD
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VALUATION
Description FEE Description FEE
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Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Z/O
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing Base Fee
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
X DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERmrrAppucATibm isomys
IL PERMIT UMM I YEAR - PROVIDED WORK ISSTARTEDWITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPUCAN17; 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. WASWINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
- Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE'OF'7HIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Ajnt. DiIe
DEEMEDXO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT# ANY WAY THE CHYS A BILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I'HEREEIY 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 OWNEFL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This applicallon is not a permit unW signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE'LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION recelpt Is acimovAefted In space ixovided.
WORKMEWSPOWE*TION INSURANCE AND RCW 10.27.
OFFICIAL$ SIGNATURE D TE
A
AGEPJJ,-' DATE SIGPED/
Z
�771-0220 DAtE
RELEASED BY
A M�NTION
EXT 1333 - -----
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL-.40R'A-�E14TIVI'. ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTON 109
Pin - OWNER GOLD - ASSESSOR
091m PRESS HARD -YOU ARE MAKING 4 COPIES