20051074.pdfDATE RECEIVED
PERMIT EXPIRESSE
CITY OF EDMONDS ZONE Nu BIER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS7 /,/_
OWNE NAMEINAME OF BUSINESS (�J ! •J /
0� �% PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING A RESS / LID FEE $
ji/� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP PW Pe mit Requived Q
l RW Permit Roqulrnd O
Street Use Permit Poq'd tj
CITY ZIP TEL HONE EXISTING PROPOSED Inspection Required O
Sidewalk Required
l l�itC�f L)�� ✓ `% 7 �C! REQUIRED DEDICATION Wiring requUndefgrounired Q
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED O
YES ❑ NO ❑ z
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ADDRESS REMARKS�:.,�..e.�r z
z
OWNER/C In I L/DRAINAGE z
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CITYZIP TELEPHONE pressure/relief valve an approved
r listed expansion tank shall be
.NAME CBL # 1 in$ a e on- all hot water tanks,
✓� �// Com' �' C../•'�/ �� ENGINEERI� i DATE
ADDRESS J%� �/q /�i %/� f j ) .-, •.,_, _.____ ���,
FIRE R Y W
CS 17Y � Ip� TELEPHONE � �
or L vent connectors re�T llre�
�STATE LICENSE �NUMB/E�R � EXPIRATI N DATE CHECK BY VARIANgg gh l J # s. NSREEM" 803 SNT
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SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCO U PARCEL NO.pj•��//���� COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
�•� / OQC JLJ C)o EXP
❑ NEW RESIDENTIAL MLM�BIN / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REARCOMPLIANCE OR
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❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE z
❑
REMODEL MULTIFAMILY PARKING LOT AREA PLANNING REVIEWED BY DATE 5 ❑. ❑ SIGN REQ'D , PROVIDED a
❑ REPAIR ❑ GRADING ❑ FENCE
CYDS ( X FT) REMARKS
OTHER
❑ DEMOLISH ❑ TA14KGARAGE FIRE
❑
❑ CARPORT 13R CKIERY WALL 13FIRE ALARM SPRINKLER
(TYPE OF USE; BUSINESS OR ACTIVITY) EXPLAIN: � —
CHECKED 8Y ITWWCO(�Sj( 1C ON77)
GROUPAUI/�/) GROUP
REMARKS
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
STORIES � UNITS NUMBER REQUIRED ❑ LOAD
YES
DESCRIBE WORK TO BE DONE
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D 9
C % U V(J�2)i _VVALUATION
d Gam,c�.e4 0_ $
- FEE Description FEE
lb
Description p
l 1�2G Plan Check State Surcharge
( HEATS URCE GLAANG % LOT SLOPE %
Building Permit City Surcharge.
PLAN CHECK NO: VESTED DATE Plumbing_
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
1= SEPARATE PERMISSION.
i Engn Review
WPERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR • PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
r�
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit
u� 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 N
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.` Lo
Recording Fee Receipt N
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- CALL This application in not a ponnil until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/hor Doputy: and Feas are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rocolpllsacknowledged Inspace provided
WORKMEN'S COMPENS ON INSURANCE AND RCW 18.27.
Olill ICIALS ONAT 1F DATE
SIGN URE (OWNE 0 A N DA ELl
SI NED ) (425)
� ` �/71 f 771 =0220 RFI EA3 _ Il DATE:
ENTION 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• OHIGINAL • FILE YELLOW • INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK • OWNER COLD • ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES Gnc[N ACCOUNTING
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