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DATE RECEIVED .
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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ADDRESS
CITY ZIP TELEPHONE
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NAME ` • , CBL#
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ADDRESS
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CITY. ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
00 0j 74Z o U Y Ida 100
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH
❑ COMMERCIAL COMPLIANCE OR
2*OADDITION ❑ MIXED USE CHANGE OF USE
❑
❑ REMODEL ❑ MULTIFAMILY L_I SIGN
G DING ❑ FENCE
❑ REPAIR �, ^ CYDS ( X FT.)
❑ DEMOLISH ❑ TANK ❑ OTHER
❑GARAGE RETAININIRE
CARPORT ❑ ROCKERYG WALL ❑ FIREA ARM SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
45 FF�
NUMBER NUMBER OF
OF( DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
PERMIT EXPIRES _
PERMIT
NUMBER
JOB—, U1 (APT#
ADDRESS /^
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PLAT NAMEISUBDIVISION NO. LOT NO, LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Re, 13
Street Use Permit Required E3
EXISTING _PROPOSED Inspection Required E3
Sidewalk Required 0
REQUIRED DEDICATION FT _ Wiring eu it E3
— Wiring requited E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED .
&iliiils YES 13 NO13 re
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REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE a
N INEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE ur
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SE
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REQ'D COMPLETED EXEMPL. _
0 YES O ✓ 'T1
CA# Ll ILZONE SIGN AREA HEIGHT CA =
WAIVER r ALLOWED PROPOSED ALLOWED PROPOSED Q mSTUDY 0 z/ / ' f m 0
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) n
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
R O i O C
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PARKING LOTAREA PLANNING REVIEVjED BY DATE �� Z��y g I p Z
REQ'D PROVIDED f�
REMARKS y f r� ` r =
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TYPE OF 0S TION D OCCUPANT M m
, � GROUP 0 5
SPECIAL INSPECTION CONSULTANT OCCLOAUPANT n rn
REQUIRED [3 YES
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REMARKS z t m 0
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O % O F e AroylLnm GEOTECH REPORT
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BY:
STRUCTURAL DESIGN
BY:
VALUATION .j Z
7153
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Description 1 FEE Description FEE OZ
Plan Check . — State Surcharge
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HEA�QU_ RCE LOT SLOPE°h VESTED DATE ITl
Building Permit City Surcharge
PLAN CHECK NO: _ Plumbing Base Fee
Q•
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. 41S PERMIT COVERS WORK TO MBChanIC2I
f- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
1 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
� SEPARATE PERMISSION.
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
9L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION 1
79
ryir 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit!
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire IRSpeCilOn Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY h
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE �v
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL y
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees are pad, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt Is acknowledged In space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, FFI LS SIGNAT E DATE
SIGNATUff(OWNEf OR G ): DATE SIGNED (425)
h 1 I v
771-0220 ` RE SE BY JDATE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE • YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC1106 PINK -OWNER • GOLD - ASSESSOR
10/04 PRESS HARD = YOU ARE MAKING 4 COPIES
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N INEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE ur
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SE
PA
REQ'D COMPLETED EXEMPL. _
0 YES O ✓ 'T1
CA# Ll ILZONE SIGN AREA HEIGHT CA =
WAIVER r ALLOWED PROPOSED ALLOWED PROPOSED Q mSTUDY 0 z/ / ' f m 0
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) n
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
R O i O C
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PARKING LOTAREA PLANNING REVIEVjED BY DATE �� Z��y g I p Z
REQ'D PROVIDED f�
REMARKS y f r� ` r =
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TYPE OF 0S TION D OCCUPANT M m
, � GROUP 0 5
SPECIAL INSPECTION CONSULTANT OCCLOAUPANT n rn
REQUIRED [3 YES
ic�
REMARKS z t m 0
o � 1—
O % O F e AroylLnm GEOTECH REPORT
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BY:
STRUCTURAL DESIGN
BY:
VALUATION .j Z
7153
�
7 5 3
Description 1 FEE Description FEE OZ
Plan Check . — State Surcharge
n
HEA�QU_ RCE LOT SLOPE°h VESTED DATE ITl
Building Permit City Surcharge
PLAN CHECK NO: _ Plumbing Base Fee
Q•
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. 41S PERMIT COVERS WORK TO MBChanIC2I
f- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
1 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
� SEPARATE PERMISSION.
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
9L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION 1
79
ryir 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit!
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire IRSpeCilOn Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY h
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE �v
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL y
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees are pad, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt Is acknowledged In space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, FFI LS SIGNAT E DATE
SIGNATUff(OWNEf OR G ): DATE SIGNED (425)
h 1 I v
771-0220 ` RE SE BY JDATE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE • YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC1106 PINK -OWNER • GOLD - ASSESSOR
10/04 PRESS HARD = YOU ARE MAKING 4 COPIES
' Zone1�-,'? �/ Corner/ Flag
w0JECT ADDRESS/ OWNERS:
A 100 Setbacks Rfouired Actual—� BRAD & LINDA JOHNSON
1F 0 • too Front ._ :- 902 MAIN STREET
C. tb4 Sides ��y EDMONDS 98020
100' Rear .
425 697 2994 home
�{D a 44 = 100 ',��!@ � 206 999 8405 Brad's cell
• t j,. TAX PARCEL No: 004342 06800100
loo4Z5 = l25'Ni
LEGAL:
ll(o� �Q-OpD�l��•
CITY OF EDMONDS BLK 68 LOTS I & 2.
. Mat�.1 �T
• -� SCOPE OF PROJECT: ZO
ADDITION OF 160 SQ FT ROOM OFF KITCHEr
OWNER
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