20050473.pdft r 9 / r UAIE KEGL•IVEU �' 41 PERMIT EXPIRESllifn okl� all i �w IF
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USE PERMIT .
CITY OF EDMONDS LONE ��'� NUMBER &) r -
CONSTRUCTION PERMIT APPLICATION JOD suITE/APTk
ADDflESS
OWNER NAME/NAME OF BUSINESS��
1 PLAT NAMEISUBDIVISION Nd LOT NO. LID NO.
MAILING ADDRESS
/ I` LID FEE $
c PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Pe Approved O .
Z L 3 �" r l �* RW Permit PermitRequired LLLp777
Suool Ueo Permit Roq'd
inspectCITY ZIP TELEPHONE EXISTING PROPOSED Sidewalk Required ❑
Sidewalk Required ❑
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REQUIRED DEDICATION FT Wiring required ❑
NAME METER SIZE LINE.SIZE, NO, OF FIXTURES PRV REQUIRED t7
YES ❑ NO 13_
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ADDRESS REMARKS 2
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z
CITY ZIP TELEPHONE
NAME CBL #' p
ev O r /• ENGINEERING REVIEWE BY PATE
ADDRESS % 4?di)
FIRE REVIEWED BY DATE w
CITY cc ZIP TELEPHONE cc
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141z's %4' 3c' 3S� VARIANCE OP CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE C BY PCd*VI�AAv •A RE°'D POSTED
�j r Aar T-Af r10YES ®NO $ ../
SEPA REVIEW SIGN AREA HEIGHT
( PROPER TAX ACCOUNT PARCEL NO. - COMPLETE EXEMPT ALLOWED iii I
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PROPOSSE/D�� ALLOWED PROPOSED
EXP I � i/a�111/' 12I1b
/ MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL PLUMBING
❑ ❑ ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR c7
COMPLIANCE OR , � � ' Joe � .0000"q
❑ ADDITION COMMERCIAL ❑ CHANGE OF USE
�� PARKING LOT AREA PLANNING REVIEWED BY DATE 5
❑ REMODEL IL
❑ MULTIFAMILY .� "C,N RE/OD PROV�D ,/ � C�� OI _/ D(01C
GRADING FENCE IBJ I `��✓✓
❑ REPAIR ❑ CYDS ❑ ( X FT) REMARKS
1:1DEMOLISH ❑ TANK ❑ OTHER
z 1:1GARAGE RETAFIRE
CARPORT ❑ R CKIERY NING WALL ❑ FIRE ALARM SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE 0 CO TRUC IONOCCUPANT
cc ccr s7ex" N.(WelGROUP
n . NUMBER J NUMBER OF CRITICAL
OF DWELLING ► \ AREAS SPECIAL INSPECTIO1 AREA OCCUPANT
OSTORIES UNITS �J *' NUMBER)11REQUIRED ❑ YES LOAD
DESCRIBE WORK TO BE DONE .
REMARKS i
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9
VALUATION
Description FEE Description FEE
Plan Check tea State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
City Surcharge
Building Permit t
PLAN CHECK NO: -y 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 Grading
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr, Review
W PERMIT APPUCATION: 180 DAYS
a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
H'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Flre Review Plan Chk. Deposit I
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
S DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape lnsp. Total Amt, Due
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
_ Recording Fee Receipt #
I HEREBY ACK14OWLEDGE 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 SURANCE =W 18.27,
FI S SIGNAT E DATE
SIGNATURE (OWNER GEN DATE S GNE (425) /�M01A
I �'v
771 -0220 R SE Y DA E
ATttNTION EXT 1333 ,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- IGINAL. FILELLOW - I SPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC. SECTION 109 PINK - OWNE • GOLD - ASSESSOR
04/02 PRESS HARD =YOU ARE MAKING 5 COME GREEN - ACCOUNTING
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