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CITY OF EDMONDS ZONE / 7 PERMIT
CONSTRUCTION PERMIT APPLICATION / 1 J
JOB NUMBER 215 6&q / UITE-APT
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OWNER NAME NAME O BUSINESS ADDRESS // �%�(/ �.//►
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O ` `� ' U PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
CITY ZIPW TELEPHONE NUMBER
Al EXISTING _ RW Permit Required ❑
REQUIRED DEDICATION Street Use Permit Req'd ❑
PROPOSED Inspection Required ❑
NAME Sidewalk Required ❑
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1. METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS./YES ❑ NO ❑
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NAME / W
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ENGINEERING MEMO DATED
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O FIRE MEMO DATED REVIEWED BY W
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SIGN AREA SEPA REVIEW ADB
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
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- SETBACKS — EET HEIGHT LOT VERA E _
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Tax Account 7/ % j /'�/�/1�'��/'��%/� /��0 Y REMARKS a
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NEW RT RESIDENTIAL 0 PLUMBING
ADDITION COMMERCIAL F1 MECHANICAL
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REMODEL 1:1APT. BLDG. LJ SIGN
GRADING FENCE CHECKED BY TYPE OF CONSTRUCTI N CODE OCCUPANT If
' REPAIR El CYDS. ( x_Fr) �\�/j`� / GROUP
DEMOLISH ❑ INOORPOOL UB SPA DSTOVE HOT TSPECIAL INSPECTOR AREA ^ `_ OCCUPANT
��C REQUIRED YES '" LOAD
j� CARPORT ROCKERY WALL/ ❑ RENEWAL REMARKS
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC SO5 0
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DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE: GLAZING BUILDING 61ZO
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PLUMBING
Plan Check No. 4 MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
N successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
m employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuance �7/
M of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT "4it
omodify, waive or reduce any requirement of any city ordinance
= nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE /
provision." �! 17 p
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz• AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27. INSPECTION acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
��❑I G �j 1711CITY OF IA 'S ATURE DATE
EDMONDS
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CALL FOR RELEAS DATE
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� ®��® \.
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspectn�''
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3. PINK — Owner GOLD — A"
102.87
EXEMPTION FROM CONTRACTOR REGISTRATION
VERIFICATION FORM
The undersigned property owner or contractor has applied for a building permit from the
City of Edmonds and claims that he/she/it are exempt from providing contractor registration in
accordance with the provisions of RCW 18.27. The property owner, by their`signature below
hereby verifies to the City of Edmonds that;
❑ Value of work under $500.00. The aggregate contract price of labor and
materials and all other items required for the project is less than $500.00 and
is not part of,a larger operation to be undertaken on the property. The
person employed to do this work has not advertised nor otherwise put
himself forward to the permittee to be a contractor or qualified to engage in
the business of a contract. RCW 18.27.090(9).
Work performed personally on own property. The undersigned verifies
that all work done under this permit will be done by the permittee personally
on his/her own property and that the improvements constructed on the
property are not being undertaken with the intention and purpose of selling
the improved property.
❑ Commercial property exemption. The permittee is the owner of
commercial property and the owner's own employees will perform all
maintenance, repair and alteration work on the property. No work will be
done by contract under the permit. RCW 18.27.090(13).
❑ Licensed architect, engineer, electrician or plumber. All work performed
under this permit will be performed by an architect, civil or professional
engineer, licensed electrician or licensed plumber operating within the scope
of his or her license. RCW 18.27,090(14),
THE UNDERSIGNED PROPERTY OWNER HEREBY VERIFIES THAT ALL
INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST
OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE, HE OR SHE UNDERSTANDS
THAT THE BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES
PAID FORFEITED.
DATED this 2 `5 day of �0 )u�C, 19934
PROPERTY OWNER/PERMITTEE
WITNESS:
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CITY OF EDMONDSIL
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x LAURA M. HALL u
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250 It5TH AVE. N. • EDMONDS, WA 98020 (206) 771-0220 FAX (206) 771-0221 MAYOR t PI
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COMMUNITY SERVICES DEPARTMENT, L:
1 O Public Works . Planning Parks and Recreation • Engineering y:
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November 19, 1993
Teresa SI YaIt
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Nagel Design 7
115 4th Ave S., #E f'"
Edmonds, WA 98020 tit.
RE: Building Permit Plan Check # 93-203
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Dear Ms. Slye: a i.
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During plan review of the above noted project, it was found that height calculations are still
needed. Enclosed is a handout for your information regarding the procedure for calculating Y2'
height calcs. #,
Should you have any questions, please contact me at 771-0220.
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Sincerely,
Ann Bullis ,n
File 93-203 Allot
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Incorporated August 11, 1890 •
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