20050663.pdf•uw
DATE RECEIVED✓'
%� PERMIT EXPIRES
CITY OF EDMONDS ` ZONE V r' � (4L
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/Arra
ADDRESS � A' � t
OWNE M / E OF, USINESS a %�
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MmdlRqsq LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit
Approved
Street Use Permit Raq'd g
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ZITELEPHONE EXISTING PROPOSED Inspection Required Q
P
P / Sidewalk Required Q�vr REQUIRED DEDICATION E7 Underground
Wider required Q
NAME METER.SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO ❑ z
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ADDRESS REMARKS z
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
Z
Q W
CITY ZIP TELEPHONE
ftME _� CBL g'
ENGINEERING REVIEWED BY DATE
¢ ADDRESS
1 FIRE REVIEWED BY DATE Q
C IPTELEPHONE lZ
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBM INSPECTION BOND
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� REO'D POSTED
L4/i �'1,1& N YES ONO 5
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP �✓/� Z7 �.. 19.Sr
EC LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1:1 NEW ❑ RESIDENTIALIUMBING
ALLOWED PROPOSED FRONT SIDE . REAR FRONT UR SIDE REAR
COMPLIANCE OR L Z
❑ ADDITION COMMERCIAL ❑ N&
CHANGE OF USE � _
PARKING LOT AREA PLANNING REVIEWED BY DATEILS
REMODEL ❑ MULTIFAMILY ❑ SIGN REDID PROVIDED
W 01011117
FENCE NL �!'t
❑ REPAIR 13 GRADING CYDS ❑ ( X Fr) REMARKS
OTHER * `GW Gail Lt /tJt M h ✓ nLA
❑ DEMOLISH ❑ TANK ❑ ! M $1110 '110.4 _
❑GARAGE RETAINING WALLFIRE SPRINKLER
CARPORT 13 ROCKERY ❑ FIRE ALARM
(TYPE OF B SS ORA IV EXPLAIN:
I iQs �(� CHECKED BY TYPE CONSTRUCT CO GROUPANT
NUMBER NUMBER OF `7v CRITICAL
O OF DWELLING n� YES
AREAS SPECIAL INSPECTION AREA OCCUPANT
O STORIES UNITS / Y NUMBER REQUIRED LOAD
1 4 X.7
D CRIB WTO BE DONEIF
PROGRESS INSPECTIONS PER UBC 106/IBC109/IRC109 FINALINSPECTION REQ' 9
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VALUATION
C�v�l?x $
. vOiis P Lk Description FEE Description FEE
j Plan Check . State Surcharge
HEAT SOURCE Ii GLAZING % LOT SLOPE %
Building Permit City Surcharge
O�7 Alt
PLAN CHECK N VESTED DATE Plumbing ' Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Gradin
j DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
i Engr. Review
W PERMIT APPLICATION: 180 DAYS
a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 186 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt %I
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
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
MINIM Recording Fee Receipt I!
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-7FORR
ALL This application is not a permit until signed by the
TION ND IN DOING TIE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED This
Official or his/her Deputy: and Fees are paid, and
IN V, O TION OF T BOR CODE OF THE STATE OF WASHINGTON RELATING TO SPECTION receipt is acknowledged In space provided.
WQRK EN'S COMPrSjI0P INSURANCEA
41 A JPD RCW 18.27,
OFFICIALS SIGNATURE DATE
' S NAIIEIN E GATES NED � (425) r1 b�L
�T� 1/1' L W
771-0220 REL ED D E
ENTI N EXT 1333
ITIS LAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPE TION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY
IAAL- Y LLOW • IN PECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. I OLD -ASSESSOR
09/03 PRESS HARD =YOU ARE MAKING 4.COPIES