20050840.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NIUMBE
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS Ll
OWNER NAME/NAME OF BUSINESS
D'o-t\N 1) e- �— PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
cc MAILING ADDRESS I (D LID FEE S
LU Uv�
7ESCP ApprovWd
SLJ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
0 Street Use Permit Roq'd 13.
CITY ZI ELEPHONE EXISTING — PROPOSED inspection RaqL:1,1d0d
Sidewalk Requii
REQUIRED DEDICATION 0"00� FT underground
L--�-f f cj 7-:;7 Winne required
N METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIREO'
140 1 11 z
YES 13 NO 13
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ADDRESS. REMARKS 3
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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NAME CBLN
ENGINEER(ING REVIEWED BY 6AT�E
ADDRESS _-2 i �,;r 17
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FIRE REVIEWED BY DATE
CITY TELEPHONE cc
Zip U.
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0 qJ -qj(�16�3 RIANCE SHORELINE OR ADBN *SPECTION BOND
STATE. L CENSE NUMBER EXPIRAT CHECKED B J+4eA'e V) Ir- REO'D POSTED
VA 30� YES ONO S Z
24 SEPA REVIEW SIGN AREA ' * HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
0 oo 00�� EXP :331-11
PLUMBING / MECH LOT COVERAGE P"' REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT 4!)ft7lDE R
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COMPLIANCE OR W/ F, N S 4j S-
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ADDITION COMMERCIAL CHANGE OF USE �b IF 2,1q' 24 110� 10 1 L�% 6110 157 z
PARKING I LOT AREA I PLANNING REVIEWED, BY DATE
REMODEL El MULTIFAMILY, El SIGN REO'D I PROVIDED IS
El REPAIR TAD I ING FENCE 2-
to 0 CYDS X FT) REMARKS
9216iAnt AYCZ* 0--) bb DIAM M
DEMOLISH El TANK OTHER
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CARPORT [3 ROCKERY FIRE At -ARM E7" Own oytli, !E�7 p I a*,,-o
"E OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF 9ONSTRUCTION 7CODE OCCUPANT
ic GROUP R3
13 NUM13ER NUMBER OF CRITICAL
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0 OF DWELLING FARTEA SPECIAL INSPE ION OCCUPANT
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0 STORIES -- UM D`3kYE LOAD
I UNITS N M B E R '7L REQUIRE
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/ IRC109 FINAL INSPECTION REQ'D
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VALUATION
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q Description FEE Description FEE
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csv;�. Irciliq Plan Check 7 tA State Surcharge g.7,9�
"EAT tUPICE GLAZING % LOT SLOPE % Building Permit I . ) -0e City Surcharge
,_ 1� S _P �� - ;i 619 6
PLAN CHECK NO: VESTED DATE Plumbing .01 Base Fee
Mechanical 1270
T HIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO -
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Ir LW
ul PERMIT APPLICATION: 180DAYS I � -
PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON 13ERALF 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
9 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPFIOVAL
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 VIOLAT 0 H LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKM2S 0 P NESATION INSURANCE AND RCW 18.27.
MOP I LS SIGNIIARE DATE
LSLIGNATURE WO GENT) DATE SIGNED (425) �0
IT
771-0220 R7 1: U By A4AT
ATTENTIO EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL n"AP/2L W420101
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIG:NAL-FILE YELL0W-(NSPEC;rR'
PANCY HAS BEEN GRANTED. UBC109/16CIiO/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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'OTAL 2,585 5aUARE FEET
AUG' 1. 0 261i"
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WILDING DEPARTMEN'T
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CITY OF EDMONDS
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