20050336.pdfDATE RECE IVED
PERMIT EXPIRES 111C2 L5-
CITY OF
EDMONDS
USE PERMIT
ZONE NUMBER
alba;70)3�
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/API A,
ADDRESS -3 q q N
C7 _?L W
OWNER NAMEiNAME OF BUSINESS
-A
PLAT NAM EtSUBDIVI SION NO
LOT NO,
LID NO.
uD FEE
CC
W
z
MAILING ADDRESS
') z> \V, J,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
0
0
0
" e�-
EXISTING PROPOSED
Street Use permit Req d
inspection Required
Sidewalk Required
0
0
0
CITY ZIP
TELEPHONE
U
W
REQUIRE17
ME11111 SI
NAME
ADDRESS
REMARKS
OWNER,CC
CITY ZIP
TELEPHONE
I
0
IRED
C
40 0 9
CC
W
z
z
a
W
NAME
7_
A?r-'77 C) /--)if rc ENGINEERING REVIEWED/DATE
im ADDRESS
nR -7R I W Day DATE W
oil f
UQ_ CC
burning appliances passing
z C T' ZIP T LEPHONE,(Y� IL
0
dirrillgh inhented s aces, DIC 803.2
'1557 11 1 BOND
STATE LICENSE NUMBER E I CHECKEDPY REO'D POSTED
6JI4'�5nlo 1-1741 W 0 YES 0 NO I
SEPA REVIEW SIGN AREA HEIGHT
-JI PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
W
EXP
LOT COVERXW& eA?TEmL%,(Wj- OPOSED SETBACKS (FT.)
NEW tLR3�' RESIDENTIAL NT
PLUMBING MECH ALLOWED PR ICEffif f; UR SIDE REAR
W;l46 z
COMPLIANCE OR WALI, � 113 INSTAUXI) 0 F
ADDITION COMMERCIAL CHANGE OF USE z
PA R K I A, ftllnr� 14M FHiffWjNrj DATE _j
REMODEL C] APARTMENT Cj SIGN REO'D I PROVIDED 0.
CYDS FENCE
608
REPAIR GRADING X Fi) REMARKS
ArpMSURE'RFG1MMRVALVE(P11V)
F-1 OTHER
DEMOLISH TANK SHALLWOiSTAIIED NFAR
GARAGE RETAINING WALL RENEWAL
ROCK
z CARPORT 'CRY
(TYPE OF USE. BUSINESS OR �CT�IVITY) E�PLAIN' OCCUPAN�,3
.�& CHECKED BY TYPE OF.CONSTRUCTION CODEU
GROUP
L)
to I -PLUMB
uj NUMBER NUMBER OF CRITICAL
0 SPECIAL INSPECTOR AREA OCCUPANT
to OF DWELLING AREAS
0 STORIES UNITS NUMBER REQUIRED E] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 2i
5
GAS PIPE TEST MUST BE m
Z+ el r - - OBSERVED BY CITY INSPECTOR
-7,5_(-4-Z '70,000
NOT
AFFIDAVITS SHALL
L-OL BE AUMED
VALUATION FEE
PLAN CHECK FEE
HEAT LIKE GLAZING % LOT SLOPE BUILDING
PLAN CHtCK NO: VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
1-YURCHARGE
j SEPARATE PERMISSION.
Cr. PERmi-rAPPLICAT16N: 180 DAYS
Uj
0. PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG BLV��
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(4 *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE HEIRS. ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
to
IN INTEREST. AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE a ry OF LANDSCAPING
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
m FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." RECEIR
TOTAL AMOUNT DUE 00
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 This application is not it pounit until signed by the
THEOWNER. I AGREE TO COMPLY WITH CITY AND sixrE LAWS REGULATING CONS] RUC. CALL
TION ' AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION Building Official or his/her DOPLIty: and Foes are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknowledged in space provided.
WORKMEN'S COMPENSATI ON INSURANCE AND RCW 182�1, n f:% OFJ�CIA IIGN/n �DATE
RE (OWNEI DATE SIGNED .51 100
SIGNATU 1 (42
-0220 RELE D BY
.4� 771 DATE
A -MENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR,--,
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
5198
2 1910 A
I
Alll� !___I
Wiringraquired
JL ti U�mtky?ll L
L
ll
PRV REO
1�1
pr surelrelilf
valve, an approwd
Tfik sball
-listed expansion a
Ue-
4TRACTOR REyONSIBL5j2R
ERO;��Vj"W�AGE
AnnilL481CU U11 all
UPC— 608
1149JL
z
0
m
--1 '11
M
C
M
0
-40
0 C:
M
M Z
IC) --I
C _z
0 -n
n
-4
m m
C)
0
0 M
C (j)
9 Cn
M 0
Z
z
__4
z
0
i
3
m