20040975.pdfDATE RECEIVED /J
PERMIT EXPIRES (�
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CITY OF EDMONDS ZONE PERMIT
NUMBER l.� � �• � • t, � L—�
CONSTRUCTION PERMIT APPLICATION JOB �" SUITE/APT#
ADDRESS
NNE
OWNER NAME/NAME OF BUSINESS
{\� PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
W MAILING ADDRESS_ LID FEE S
J % TESCP Approved - 0
0 7 :e j'vrD j% PUBLIC flIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street Use Permit Roq'd E3
CITY EXISTING Inspection Required p
21P TELEPHONE PROPOSED
Sidewalk Requited Q
REQUIRED DEDICATION Fr UndarWiring required
Wiring required El
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO. ❑ Q
W
ADDRESS REMARKS =
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
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CITY ZIP TELEPHONE
NAME CBL#
ENGINEERING REVIEWED BY DATE
is ADDRESS
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F E IEWE Y DATE w¢
CIN ZIPITELEPHONE I ( ` lU� W
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY ARIANCE O CU SHORELINE OR ADB# INSPECTION BOND
D v �,V �� REO'D POSTED
iff 0 NO/(_
OYES ONO g
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAXU►dr PARCEL NO^�� COMPLETE EXEMPT ALL PROPOSED ALLOWED PROPOSED
QT Z t//�! G!f EXP
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMPLIANCE OR
❑ ADDITION ❑ COMMERCIAL ❑re
CHANGE OF USE _
MULTIFAMILY PARKING LOT AREA PLANNING REVIEWED BY DATE I
REMODEL `
❑ � ❑ SIGN REO'D PROVIDED
❑❑GRADING ❑ FENCE
REPAIR CYDS ( X FT) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER A' , % �j n
GARAGE RETAINING WALL IRE RINKLER � ,moi / QjJ ��
❑ CARPORT ❑ ROCKERY iGl VIVA tAlw
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fr CHECKED BY [WF CONSTRUCTION COPE OCCUPANT
t�IV7 GROUP ,
C NUMBERZ NUMBER OF CRITICAL
m OF 3 DWELLING AREAS dd SPECIAL INSPECTION JAREA OCCUPAN
STORIES UNITS. NUMBER n REQUIRED []YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS =
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109FlNALINSPECTIONREO'D 9
�wlr✓ .. L6nOt17 VALUATION
$ pr'
Description FEE Description FEE
Plan Check 334 State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % j
Building Permit Z City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
s Engr. Review
W PERMIT APPLICATION: 100 DAYS _
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
y MENNEN
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review /Oo Plan Chk. Deposit
ry IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Q EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection O�). f 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
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
3cl Recording Fee Receipt #
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 INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATIO NCE AND RCW 10.27.
O !NZA% DATE
SIGNAT NER E / DATE SI NED (425)
771w0220 ELEASED Y DATE
ATT &TION EXT 1333 f '
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL �� • �Z,
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ECTOR
PANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110. oPIGI LE YELL
PINK -OWNER .• GOLD -ASSESSOR SSESSORSOR
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