20050057.pdfDATE RECEIVED PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OF BUSINESS ADDRESS
OWNER NAME/NAME P
PLAT NAM E/SUBDIVI SION NO. LOT NO. LID NO.
(11 re e-r
um MAILING ADFIRESS LID FEE S
TESCP AFP�rovedQ
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required E3
0 1140 Street Use Permit Roq'd C3
CITY Insprictitin Required 13
ZIP TELEPHONE EXISTING — PROPOSED Sidewalk Required E3
ltt2'r 19 y! 2 REQUIRED DEDICATION— FT 1 Underground [3
wiring required
NAME METER SIZE LINE SIZE _1__�07017 FIXTURES PRV REQUIRED
YES 0 NO 0
ADDRESS REMARKS
x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CITY ZIP TELEPHONE
NAME CBL
(60j I - - .
if2:IAO'� r ENGINEERING REVIEWED BY DATE
ADDRESS
0
A4 FIRE REVIEWED BY DATE ul
CITY TELEPHONE
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_43
19A'el 1 VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER E IRATION DATE CHQCKED BY REO'D POSTED
( e 4101�1111, r7 61 11 X I . 10YES ONO !$' —
Sa-i ( oa Dos (Ad SEPA REVIEW SIGN AREA HEIGHT
PROPERTY J:A� ACCO PARCEL NO. COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
NEW RESIDENTIAL LUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR, FRONT UR SIDE REAR 0
POMPLIANCE OR
ADDITION COMMERCIAL CHAN
GE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D I PROVIDED
GRADING FENCE
REPAIR rynq ( _ X _ Fr) REMARKS A-Irt 11:1)1- RIUST BE
DEMOLISH TANK OTHER OBSERVED By C117 INSPECTOR
GARAGE RETAINING WALL FIRE SPRINKLER
FIRE ALARM 10 011ALL NUT
z CARPORT ROCKERY AFFIDAVIT
nit -
(TYPE OF USE, BUSINESS OR�A�CTEIPAIN:
.4 CHECKED BY I TYPE cl 11i E: I- Qk OCCUPANT
FE Z/,- i GROUP
M NUMBER NUMBER OF CRITICAL 2e),r
93 �& AREAS SPECIAL INSPECTIOA JAREA OCCUPANT
in OF g!:� DWELLING
0 STORES ai UNITS NUMBER REQUIRED [:] YES LOAD
7
DESCRIBE WORK TO BE DONE
REMARKS
4�)l PROGRESS INSPECTIONS PER UBC 108/IBC1091IRC109 FINALINSPECTION REO'D
ILI I,
A
otno C I I ki Qez (ez J�< itype is or L vent connectors required
VALUATIO
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wo v4o� C�ca- _�C) -I Description FEE Description FEE
R,,e,_'cVCb14.,j 1!26'o( Qei Pip I A"i Plan Check State Surcharge
Hrj4UrE GLAZING % IOT SLOPE % Building Permit C4 Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
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
W PERMIT APPUCATION: 180 DAYS
CL PERMIT LIMIT 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
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire inspection Receipt #
RISING DIRECTLY 0
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, A R INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
LandscapeInsp. Total Amt. Due 9A5
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE L
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording F
M1 . ' ee Receipt # Lai
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- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL 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 COMPENSATION PSU �ANCE AND RCW 1B.27. F IALS SIGI)IAPRE IDA E
SIGNATUO (OWNER OR NED (425) 67011
'0
771-0220 ifftI!FA§L1?DBY DAY
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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