20000009A.pdfDATE 1110ENIO
[PERMIT
EXPIRES
us
PERMIT
CITY OF EDMONDS ZONE
NUMBER
SUITVAPTN
2�a 0 '(/_� Lf kA
JOB
CONSTRUCTION PERMIT APPLICATION ADDRSSS
OWNER INAMINAME 01 BUSINESS
C P; //Os
Pt-Ar NAMEISUBDIVISON NO.
I LOT NO,
L�D NO,
31EES
MAILING ADDRESS
?q 4L) g� _-)
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
IF-. u
,:f, R.q.I 0
S-t U.. P-h R �d 0
.. R-I- 0
Ik R.q.k.d 0
CITY ZIP
/,7(
TEL11 ONE
1/;?S 7)f �3W
METER SIZE
LINE SIZE
NO. OF FIXTURES
P V REQUIRED
NAME
YES C3 NO E3
im
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY zip ITILEPHON1
NAME
ENGINEERING REVIEWED)DATE
ADDRESS
-7/7
FIRE REVIEWED BY DATE
7
CITY zip
PHONE
T!LE-
bidl
�4o
VARIANCE OR CU
SHORELINE OR ADS.
INSPECTION
AEO'CD3 NO
C3 YES
IBO
TED
DEN
STATE LICENSE NUMBER "ATGJ CHIC 08
ki P3 -7 '7 1
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED I PROPOSED
PROPERTY TAX ACCC
5 -7 61 000 010 01
EXP
I
0 NEW PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SET BACKS(FT.)
FRONT SIDE REAR
PROPOS ETB CKS
ED ETe IT
FRONT UPSIDE FEAR
ci C MPLIANGEOR
[3 ADDITION CHANGE OF USE
0 REMODEL SIGN
PARKING
REO'D PROVIDED
LOT A EA
PLANNING REVIEWED By DATE
GRAD114G CYOS (FENCE X
0 REPAIR 0 1:1
DEMOLISH TANK o OTHER
�E
L
c'AFtAGE RETAINING WALL 0 RENEWAL
CARPORT ROCK"Ay
(TYPE OF USE, BUSINESS OR ACTIVITY5
CHECKEDBY Typ
�YES
0 N67FU ON
0 P
ROUP
i0yu OCCUPAN!-ZS
2�10AG
0
OF
STORIES
NUMBER F
DWELLING
UNITS
OR TICAL
AREAS
U
N M"R
SPECIAL INS T
REQUIRED C] YES
�AR.A OCURA
DESCRIBE WORK TO BE DONE
m Te
REMA KS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REO'
-T
IF
HEAT SOURCE LOT SLOPE I
PLAN CHECK NO: rESTEII DATE
0 K N 0 E T S
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
THIS P R M T A U T H a E S 0 N L Y T H W R T
PLAIN CHECK FEE
1UILOIN6
PLUMBING
MECHANICAL
N N Y C 0 N S R
L BE GN' 0. PRIVATE PROPERTY ON- ANY CONSTRUCTION ON THE PUBLIC
E D 0 IN 0 N P R V A T P R 0 P E Y 0 L A
GRADINGIRLL
R E A Y S M A R U E
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
0 M A I N 'C R S S 0 E W A K I V W
P R M I S 0 N
SEPARATE PERMISSION.
S E A R A T
STATE SURCHARGE
A T 0 IN YS
PERMIT APPLICATION: 100 DAYS
P E R M T A P P L C
T ARTEO
YEAR PROVIDED W RK IS STARTED WITHIN 180 DAYS
R M I T L I T Y P R 0 V 'D E W 0 R K IS S
T PERMIT LIMIT: I _ " 0
ENG. REVIEW FEES
T F OF G E INFO
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
E E A P IN K P E R
HIS OR HER SPOUSE, HIRS, EI.NS AID SUCCES.FS
.APPL'C AN T 0 N H AL 0, IS OF E. PCIU BE ' HERE . ,
EN.. INEP.CTI.N FEE
-E
;APILIEC�AEN�T�C��.BEEHALFTIDF Y D E FEN - AN. HO'l
NT R E. �.E.�'FY, DEFEND AND HOLD HARMLESS THE CITY OF
IN NTE F E �T A. E E. To ".E.N
N I'
LANDSCAPING
E.P ESS ANYAND
C L Y
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM
ED-ON. S W"H N-TO N ITS OFF At".
C TLY
INSPECTION FEE
T R IN IRE
ALL C-IMS FOR DNCAGEST0HFSVHATEVE 1A 1-IRE.A.ISMODIFECTLY. G
C BE
RECEIPT
LDA
-
'R V HE S LAN E THIS PERMIT.R 'SAT C. TI OT
FROM T. 'ESUA P I SUANCE OF THIS PERMIT SHALL N
' B
I!
PLAN CHECK DEPOSIT
U. Y R CUREME,
DEEME T MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OR01NANC
T 0
0 PROVISION
CE A�
NOR U MIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY 0 ROINANCE
1 IT Y W Y HE , Y S UTYT. FOR
A
TOTAL AMOUNT DUE
CEIPT
V
THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
T
GIVEN IS CORRECT. AND THAT AM THEO O-NERD OR 'HE Dt Ly AUTHORIZED AGENT OF
AM OW E ' 0 U
Th, 'pplo.n 11 not a o.
S GU CONS Ruc
I ITY S T L W E A NG
IT
E . E R , R TO C. PLY W H I . S T L
111 AGREETOCOMP L
THE W.
OWN I YWTH C TV AN TATE A R LWILL
CALL
B"I d, g Oilk. ;.11,11
ALT RIZ 0 TH ER�.Y No BE EMPLTOYED
TION,ANDEIRNIGNOTHEWORKA HOR' ED N PE
TIO D I Do H Y
U I G T 0 LITHO Z T SFIES . 0 FSON To
0 W S I TON RELATING
F A ING
0 W
FOR INSPECTIO N
o'Pt- no I P.. P'-Ad',1
CODE OF T ST TE
ION TE
IN VIOLAT, ON O!F THE LABOR CODE OF THE STA
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OF I L
E (OWN ER OF DATE SIGNED
1
(425)
1;G91
-10W"IR
771 -0220
E E E
EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
771-0221
A FINAL IN SPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK. OWNER GOLD -ASSESSOR
Z
0
c M
MO
0
C)
c
m m
Z
ID
c
co
0 m
In
mm
0
0
0
M
c/5
m 0
Z
Z
0)
m
z
0
o
M
-0
-10
0 C
M M
Z
S)
a -n
n
m m
C)
.0
09
c
cp:
Z�
M
,a JbATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OINIIFE;��71NEII_
MAILI NO ADDRESS
CITY
,6 D
IAME
i
�DDRESS
I - . - �.. / I
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB 5
�11EIAPT*
ADDRESS A4f k A
Z_2
FLAT NAMEISUBDIVISION NO.
LOT MCI.
LID NO,
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
F
�11 U.. I.—
EXIS ING — PROPOSED-
P
REQUIRED DEDICATION— FT
METER SIZE
LINE SIZE
NO, OF FIXTURES
VREQUIREO
I
I
0 NO 13
ARKS
OWNERICONTRACTOR 13ESPONSIBLE FOR EROSION CONTqOUDRAINAGE
ITY ZIP
TELEPHONE
IAME
/� e 5 o en, -1
z
ENGINEERINV Va IlIll 5 w REVIEWEDOATE
ADDRESS
FIRE REVIEWED By DATE
r
CITY
TE EPHOMI
bi 's
510(9 5-V7 05'0
VAR FA_NCE OR CU
SHORELINE OR ADBO
INSPECTION
RE 'D
so D
POSTED
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
r1YES rIND
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
-
0 m
C=
TAX ACCOUNT PARCEL MO.
EX I
I
1
m
0
0
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Ff.)
0 NEW J5 RESIDENTIAL PLUMBING MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
c
ADDITION 0 COMMERCIAL c3 C MPLIANCEOR
CHANCE OF USE
mm
M z
PAR
I LOT
AREA
PLANNING REVIEWED By DATE
jo --i
C] REMODEL E3 APARTMENT 0 SIGN
REGO
I P VIDED
a 2
FENCE
I X
REPAIR GRADING CYGS X
RIEMAN-
DEMOLISH 0 TANK
0 _n
-n
Ei GARAGE C] FETARIINYG WALL RENEWAL
CARPORT
C IOC ER
m 9
m IT
(TYPE OF USE. BUSINESS OR A 'IVITY P
c
N
0 UPAN42�S
GCOU,
0
'm
NUMBER
UM5ER OF
NNITS
CRITICAL
AREAS
OCCUPANT
OF
STORIES
WELLING
U
NUMBER
LOAD
DESCRIBE WORK TO BE DONE
REMA KS
T"q 1(,f
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
/),/T zl)
z
--I
z
".0 r
,,(7,fe .119 Po o �5 (� W117fe
1 6 L&I fdLf LOIZ�Z
VALUATION
FEE
PLAN CHECK FEE
35
IT!
HEAT SOURCE GLAZING %
LOT SLOPE %
BUILDING
PLUMBING
PLAN CHECK NO:
I,SITEO DATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONS ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
W L REG UIRE
GRADINGIFILL
OMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) IL
SEPARATE �ERMISSION-
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
K I
PERMIT LIMIT: 1 YEAR - PROVIDED WOR S STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END, REVIEW FEES
N BEHALF OF OR HER SPOUSE, HCIRS, AESIGN� AND SUCCES.RS
'A'PL'CAN 'ioA.FE ES TO N'DSMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
IN INTERES
I EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
M 0 W T TURE RISING
LAT A AGE$ F HA EVER NA A DIR
A FOR OF
0 MIT ISSUANCE OF THIS PEFI�l� SlIZ
C IS MI
c L C TM S SUANCE OF T S P ER My Ul MEMT O;ANY ITYORDINANCE
FROM I Y WAIVE OR REDUCE A R 0 RE
DEEMED To Moo F a Ty To M SCe ORDINANCE PROVISION.'
NOR LIMIT IN ANY WAY THE CITY S A ILI E FO ANY
ENO, INSPECTION FEE
RECEIPT
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
—
TOTAL A ... T DUE
RECEIPT
2_ —D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATI N
GIVEN IS CORRECT. AND THAT I A. THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND S E LAWS REGULATING CONSTRUC
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYTED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 0
WORKMEN'$ COMPENSATION INSURANCE AND RCW 18,27.
CALL
FOR INSPECTION
(425)
I I ll-wr_Zw
APPLICATION APPROVAL
Thl, IMP11-1- -',� F"I�lt -Il lig-d by Ih,
BOO, 011"i hl�,� ?, Ty: — F — ,J. .�d
ipt ,i p— pl-l-d.
:T7,
Z�_
R'l/EASEO.1 DATE
ATTENTION
EXT 333
IT IS UNILAWFULTO USE OR 06CUPY A BUILDING OR STRUCTURE UNTIL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
ORIGINAL FILE - YELLOW. INSPECTOR
A FINAL I INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
a