20050894 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
bbl
CITY
21P TELEPHONE
r� U�Lu 4�s � 7L '� x `�
NAME
ADDRESS
CITY ZIP TELEPHONE
PERMIT EXPIRES `l /''
rartY
USE PERMIT
zoNENUMBER f; . �/'
JOB SUITF/APT#
ADDRESS
XIII V
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
CP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe Approved p
Permit Required
Street Use Permit Roq'd
EXISTING PROPOSED — Inspection Requited p
Sidewalk Required p
REQUIRED DEDICATION FT underground
Wiring required (]
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
u
YES ❑ NO ❑ _
w
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE x
W
NAME ICBL#
-it Enpau f
�?I r• �l �J` ENGINEERING REVIEWED BY DATE
WADDRESS _ Cl
&�`/ FIRE REVIEWED BY DATE w¢
C17 ZIP T LEPHON 1 S
`/ VARIANCE OR CU SHORELINE OR ADB#' INSPECTION BOND
TE LICENSE NUMBER EXPIRATI DATE CI�CKED BY OYESREO❑NO $
POSTED
_a (f
1 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX &CCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
0
O C EXP
❑ 1 X PLUMBIN MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL
T1 ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR O
COMPLIANCE NCE
z
❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE
Z
PARKING LOT AREA PLANNING REVIEWED BY DATE a
REMODEL 13 MULTIFAMILY ❑ SIGN REQ'D PROVIDED.
❑ REPAIR [3 GRADING CYDS ❑
FENCE X Fn REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
Z 1:1GARAGE FIRE
CARPORT ❑ ROCKERY RETAININGWALL ❑ FIRE ALARM SPRINKLER
E OF USE,,BU INESS OR ACTIVITY) EXPLAIN:
7 CHECKED BY PE ONST LICT N CO E OCCUPANT
rJ j /, GROUP
III NUMBER NUMBER OF CRITICAL f
OF �DWELLING AREAS SPECIAL INSPECTION AEA OCCUPANT
M STORIES UNITS NUMBER —�� REQUIRED ❑ LOAD
YES
DESCRIBE WORK TO BE DONE
t— KS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REVD 9
I m
i
-
VALUATION
$
Description . FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
BdildiRg Permit '� ity Surcharge)Ocyl
PLAN CHECK NO: VESTED DATE Plumbing
Mechanicalj
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
cc
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC Gradin
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
"r SEPARATE PERMISSION.
Engr, Review
w PERMIT APPLICATION: 180 DAYS
d PERMIT LIMIT. i YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
iqi 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 �f
9 Landscape InSp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
= 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 APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. 1 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 COMPENSATION INSURANCE AND RCW 1 FI
O FI S GNPTUP.E DATE
SIGN URE (OWNER O GENT)' DATE SIGNED (4251 ��, /IIIIIIIP
r
_._ kI ! 771m0220 RELEASE BY ? TE
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 CERTIFI- ORIGINAL -FILE YELLOW • INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN-AccouNTING
O
m.
=i9
CD _
C
m.
rn
—I O
On
C
=m
M
p 7
> Z
Q.=n
awl
M
m_
O(
n r
m
I
} Zrm
D
X
D
CA
r 0 l
m I