20040502.pdf.,.a DAT RECEIVED —
(011 Q PERMIT EXPIRES
CITY OF EDMONDS ZONE (�� NU BIER Q� W V ��
CONSTRUCTION PERMIT APPLICATION JOB QUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
% r PLAT NAM EISUBDIVISION NO. LOT NO. LID NO.
UM MAILING ADDRESS LID FEE $
Q�j Cj' %�../mss'►! e+^ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe AppRequired
roved QQ
v - I •(fes Cf J (�% Street Use Permit Req'd Q
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Required Q
Sidewalk Required Q
REQUIRED DEDICATION Wing round
Uider round d Q
MEN NAME METER SIZELLNE SIZE NO. OF FIXTURES PRV REQUIRED
O P 1NSPE N REQUIRED _
YES ❑ NO ❑
W
ADDRESS REMARK 2
VV OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE PROPERTY
1400/_ Ah WATER IMMIN TO AR 2113MOVEM 02
NAME JCB:1.14, 4$ HOSB BIB wITH AVB INSTALLED
r' \ JW ENGINEEI&G FI)t Ai APPROVED DUMP 310TONLY
ae ADDRESS
TO Bmc IT19 FIRE RE*WEftECKLIST ON HACK OF JOB SM w
CITYZIP TELEPHONE u¢—
0 FOR INSPECTION REQUIREMENTS
STAT CENSE NUMBER EXPIRATIO DATE CHEC BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
1. c�qj� CJYES ❑NO 5
�/ SEPA REVIEW SIGN AREA HEIGHT
PRQPERTY TAX ACCOUNT PARCEL NO. XOPMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
❑ NEWRESIDENTIAL ❑ PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT 1JR SIDE REAR O
COMPLIANCE OR z
❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE Z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑ REPAIR 1:1 GRADING FENCE CYDS X RERARKS
OTHER W12"5 "• Z .
DEMOLISH ❑ TANK ❑ .
GARAGE RETAINING WALL FIRE SPRINKLER �� S
2
13 GARAGE
❑ ROCKERY ❑ FIRE ALARM
O
(TYPE OF USE, BUSINE S OR ACTIVITY) EXPLAIN:
/ r CHECKED BY TYPE OF NSTRUCTION, CODE OCCUP T
6
c GROU
NUMBER NUMBER OF C 1 L
OF DWELLING AREAS i X SPECIAL INSPECTION AR OCCUP N
M STORIES UNITS NUMBERq / REQUIRED YES LOAD
DESCRIBE WORK TO BE DONE
93
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D 9
_ m
VALUATION
i
Description 'FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %7/0
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
� Engr.. Review
PERMIT APPLICATION: 180 DAYS
°' PERMIT LIMIT. 1 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
s EDMONDS, WASHINGTON, 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 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE LandSCa e Ins Total Amt. Due S
g DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE p p•
= NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.• Receipt b
r
Recording Fee
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- CALLThis application is not a permit until signed by the
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 INSPECTIO receipt is acknowledged in space provided.
WORKMEN'S CO ION INSURANCE AND RCW 18.22
ZICS GNATURE ATE
SIGNATUAMr0WNER O DATE SIGNED . (425)
771=0220
DAT
EASED BY
TTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL • FILE YELLOW - INSPECTOR
PANCYHAS BEEN GRANTED, UBC109/IBC110/IRC110, PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD =YOU ARE MAKING 4 COPIES
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