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PERMIT EXPIRES
F *PERMIT
401
CITY OF EDMONDS N U M B EfVI`4
JOB SUITEIAPTW
CONSTRUCTION PERMIT APPLICATION ADDREIS
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SuabivisION NO. LOT NO. 1_6NO.
O-C_C41-(04 VY)i 1+tt Ba Y_ k A
Ir MAILING ADDRESS' LID �EE $
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RW P"MAP 'Ovad
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP i1pRoqulied 13
38 A-V e-- 1,L; polmil Req'd E3
CITY EXISTING I nspec�'ne I'laq uired
TELEPHONE PROPOSED M
sidewalk quirod __ E3
q REQUIRED DEDICATION FT underground ' _'
__1C__aVyM1,AjS 9 winngtaquired E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO z
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t= ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 0
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CITY ZIP TELEPHONE lWk "LAS lUk
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NAME CBL#
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ERMNEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE ui
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CIT�,� ZIP ITELEPHONE
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VARIANCE U SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DAT7ECKED BY RECj0,4LO POSTED
.0+-111 OYES S 0�
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
ft.+�
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0Jq'?&'K0o7612--00 EXP
016
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW 191 RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
COMPLIANCE OR 5!!r to
ADDITION COMMERCIAL z
CHANGE OF USE %o tol- Pr/00
PARKING LOT AREA PLANNING REVIEWED BY DATE [L
REMODEL MULTIFAMILY SIGN 11ROVIDED I
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Ei FENCE
REPAIR CYDS X F-0 REMARKS
DEMOLISH TANK o OTHER
A RETAINING WALL FIRE SPRINKLER
Z Ei G RAGE o
CARPORT ROCKERY FIRE ALARM
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E MPE OF USE, BUSINgS� OR ACTIVITY11 .4 1
&C LUECKED BY TYPE OF CONSTRUCTION COPE OCCUPANT
&� /I I GROUP 12
CRITICAL 16
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uj NUMBER NU BER F
OF M AREAS SPECIAL IN�PECTION JAREA OCCUPANT
I DWELLING
o STORIES 4elyi�6 UNITS NUMBER REQUIREDA Z��AZ 051� LOAD
"I — YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109 IRC109 FINAL INSPECTION REO'D
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(M-F" L'54.5)-d Apl-�q T-? VALUATION
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Description FEE Description FEE
(�Ac jA_11 -S7-74, Plan Check
,41-3
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rr- _Tx�__ .5 1 tate Surcharge
HEAT S2URq1E 9U�;NG LOT SLOPE %
Building Permit //-/7 z1 City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing 722 Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONI V THt WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
:2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 1180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN lea 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
2 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. TotalAmt.Due V4Vr;r0jq/
0 NOR LIMIT IN ANY WAY THE CI1YS ABILITYTO ENFORCE ANY ORDINANCE PROVISION.*
T I Recording Fee 4 Receipt 0
I HEREBY ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVA��/,
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit ui
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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18-27.
OFF cl IG E DATE
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SIGNATURE( AGEN-Q DATE SIGNED
VOWNE4 R 1 (425) -.4 i�V
bt,u tz 64; 771-0220 OrLEAfED BY
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ATTENTION 1333
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IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLO(V-INSP�&OR
PANCY HAS BEEN GRANTED. UBC1 09 / IBC1 10 / IRCI 10. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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CITY OF EDMONDS 27312
T SERVICES
DEVELOPMEN
DATE:
Received of:
Addre ss z
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Phone*
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Project Name/Location.�"�Z'-'-�4'�-" '�; I . .
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Cash Total lieceived
Check No. �'-
water 'Meter, Size:
Water Connection Fee am
Sewer Permit/Repair C
mo
-10
Sewer Connection/LID Fee 0
0
Storm System Development Charge. C
Disruption :oe (Street [Sidewalk Parking Alley) Circle One
mz
Engineering Review Fees —7-91-5 --- C:
Engineering inspection Fees z
ing Plans/Specs
Engineer
ROW / Street Use / Encroachment Permit
0
Street Cut/Restoration Fee
Traffic Impact Fee
Fire Inspection Fee mm
Fire Plan Check Fee
0
Building Permit Fee - Type: OM
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Plan
Check Fee:. 9 CA
ll�eceived
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Reimbursable Consulting Fees 0
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Critical Areas
SEPA Review Fee
Shoreline Permit Fee X
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Zoning Application Feb - Type: Z
ADB Administration Fee
Sign Installation
Ma z
0
Photocopies
Recordinq Fee 0
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City Surcrlar*ge
State Surcharge (622 Fund)