20000063.pdfDATE RECEIVED d>&? PERMIT EXPIF —T77_6Ta
USE PERMIT
CITY OF EDMONDS ZONE NUMBER ;z o o a
CONSTRUCTION PERMIT APPLICATION JOB ... _7 Z",k 14 1 IT11AITI
ADDRESS
OWNER NAMEINATIF 11S11111 LID
t2
Y74 WtU.,
12_A-WP PLAT NAMEISUBDIVISION NO. I 'o No. LID FEE $
MAILING ADDRESS
VJ PUBLIC RIGHT OF WAY PER 011I.Al STREET MAP
P-1 R q�
0 TING - PROPOSED� R'l='d*
CITY ZIP �42 - 0 2-4 7_
'00,
7.t
,; ITS11PH.INE
wwopv!� 1 REOUIREDDEDJCATION-- FT - w",
NAME METER SIZE I LINE SIZE 10, 01 FIXTURES YEIRV RllUIREO
I SO NO 0
R MARKS
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE '16�,
16 ;�V Z- -7 2- IIJ P At/g; - V-j '
CITY ZIP
T
.*;?E
NAME
V-VW-NI46 a
46 C-5 AleZl 1.1 A---�
ENGINEERING E
q 6/-/ 1 /_/_
PADDRESS
+�oq 6VVWpxr AVW
FIRE REVIEWED BY DATE
CITY Z P
olmy-rr,
TELEPHONE
R CU
SHORELINE OR ADO.
tNSPEC I TION
OYRE'INO
ES
BOND
WX
STATE LICENSE NUMBER EXPIRA I
911029611 06rT
C K
COM/LETE EXEMPT
EXP
AUL.W� PROPOSED
W I
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PAR OEL N..
C] NEW E.-
[jr RESIDENTIAL Ei COMPLIANCE OR
2A..ITI.. 0 C ... EFI.AL CHANGE OF USE
R'REMODEL C] APARTMENT 0 SIGN
- 0 FENCE
REPAIR 13 WL CYDS X IT)
DEMOLISH C] TANK OTHER
GARAGE 0 RETAKININGWAIL RENEWAL
L
CARPORT P., FIT C3 ItA
LOT COV PAGE
ALLOWED PROPO 0
AEOUIRE6 SETBACKS (FT)
FRONT SIDE REAR/
oill
PROPOSED SETBACKS (FT)
FRONT �)/;E REAR
I
PKING
REO'D
I
TIDED
AM
P G IEWED BY '/DATE
MARK.
I (TYPE OF USE. BUSI ACTIVITY) EXPLAIN:
CHE KED BN�P,
TYPE 01 LICTIOl C CCU"
R3
w NUMBER
OF
T STORIES
NL
!6LIN
DWE,
UNIT
CTO
SPECIAL INE CTO
RED UIRED [D YET
L
REMARKS
OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'
fL -lb r-T A-M-n 991
IV6-W _04
C
VALUATION I FEE
PLAN CHECK FEE
=gCE
S
5 ILDING
PLAN CHECK NO:
PLUMBING
ro n- in
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS . MAROUEES, ETC.) WILL REQUIRE
PERMISSION.
AT SU CHARGE
PERMIT APPLICATION: '80 DAYS
I
1
PERMIT LIMIT. I YEAR. PRoVIDEDW.RKISSTARTE. ITHIN18DDAYS
EN. REVI EWSEE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PILIGANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESOBS
P L
P ;A T HARMLESS THE CITY OF
N DEFEND AYNEDESHOL"
I NTEREST AGREE S o
I I To
LANDSCAPING
�NDEMNICFY AGENTS FRO. ANY AND
S GTo . EMPLo AND
2 EDMONDS. WASHINGTON 'TSOFF LS
G
- ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARIFITG DIRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
I -A -
t FROM THE ISSUANCE OF IS PERMIT SHALL NOT BE
THIS PSP.,T .SUAN6E .
T'
PLAN CHECK DEPOSIT
v
�FSEPARATE
I DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NCE PROVISION,'
NOR LIMIT IN ANY WAY THE= ILITY TO ENFORCE ANY ORDINA
NO BL,.,T I Y W Y T ,
50
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFO MAIION
4 ICATION APPROVAL
GIVEN IS CORRECT AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T
THE OWNER. I AGREE TO LY WITH CITY AND STATE LAWS REGULATING CONSTRUC
C Mp
P,ly: .,d F111 ,, P.1d. Ild
TION. AND IN DING THE WORK AUTHORtZ ED THEREBY. NO PERSON WILL BE EMPLOYED
C
OF WASHINGTON RELATING TO
TION
.,I=.l,Ddg.d 11 1pa� Pf0vldQd
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN S COMPENSATION INSURANCE AND RCW 1827.
OFFICIALS SI NAT A T,
T
D ATE S GNED
(425)
6��ezy c)
SIG UREjPWNER 0
ai�l
771-0220
RELEASED Y DATE
ATTENY[ON
EXT 333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INS P ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORIGINAL - FILE - YELLOW - INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 10 9
FAX
PINK -OWNER - GOLD
54)o
z
0
m
om
c
,a :
0
0
mm
ITIZ
10-4
2
0 -n
m m
a
0
M
(A
(A
M 0
Z
.4
z
-4
X
z
m
*UAW rA)Le, W/ Nfgw
GOT Af?�eb, 14,4455, -,F
am(,. MNr rrz-le"
L�DT ccV9W-birpl GAVI HAI
W—oba-W, To MA-rCA p:Vjer�r
aAp6r. 01�,lmwr 6KL-.(, w A,
47-0
VlFP- SPEC.
&
io or Lightoller
zl' 4"
no or Lightoller
clear w/sNuired a=essorles
0
F--� rAvlM-,w- ANV
I
in CB-1 2 W/ Verdigris Patina
*f1w
A Vlj� W,w— .56me�&4
N1 surfaoe swftoh
N1 surface switch
Lhl�11.81 8040BL
k reflector In Pwdr.
178SH w/ wmn diffuser
r
IAN 1'-)'iUUU
DEVEL
SITE
PLAN
t
6�11
N �"= tO'
,�AWkZY
ME
/� * 41-r64St-lz
4V r--, W t5V KA 6 W W4. 100,?, e,��
A90-4�T;-:&T Woz, -77o'PAV�--.W. WMO-4P�
L-r-
DATE RECEW�D
PERMIT EXO
D S
CITY OF EDMONDS
PERMIT
ZONE -NIUMBER 20o06-1,"
Z N E
U M E R
P L ICATI N
CONSTRUCTION PERMIT APPLICATION
'A'.'D.ESS 330 SUITEIAPT#
AD D E
N S
3 -7 2
OWNIINAMEIN ME OF BUSINESS
AVI P * /ZA-Tj4PYW VA_-lZ4-
V
T
PI -AT NAMEISUBDIVISION NO. I IOTIO, LI NO,
Lo ' 0
LID FEE $
MAILING ADDRESS
YJ -
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw 4, LI
-L A
R ET/
P U R IG H T 0 WAY E R .. ST E �ft R11 0
J*l P1111 Rl�l 0
0
CITY ZIP NE -O.Z4Z
0
T .,--�CIAL
X S IN D
EXIS ING — PROPOSED
E R
0
ITELEPHONE
_*
ATION 'T
1.'
REQUIRED DEDICATION— IT 0
R E U IF D D ED
LINE SIZE NO. OFjIXTURES PRY REQUIRED
No OF T
X u
d4--
NAME
METER SIZE
YES Cl NO El
ADDRESS
2V 2- -72 Q t? -A VE �tj
JE
REMARKS R N NTI
'0 CO
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ZIP OF,
02
< 7
NAME
4e 4:� Ale-
V _f: H o lW'm o 0
ERI
ENGINE NO
ADDRESS
+�6)1
FIRE REVIEW DBY DATE
CITY E E
WL �11�51
CU S. ORELINE OR AOB. INSPECTION BOND
CU
DATE C UK
STATE LICENSE NUMBER E
OR
V R' NCEOR
'S
0 Y REG IN. ;r/,y
7;�;N
ARCLIL NU.
IF.IiERTY TAX ACC UNT R _ �"q _a
SEPA REVIEW IN AREA 14E T
S A REVIEW
C. L E EXEMPT ALLO;VyROFOSED ALLOWED PROPOSED
ZI 12(),qll
TE� EXEMPT
Co _� _.T<
C
E. P
EXI
2 RESIDENTIAL �> NIEC
-EC.
NEW [&L7ZIN A
LOT COVERAGE EOUIREbSUBACKS(17.) PROPOSED SETBACKS (FT)
LOT .VE PAGE
ALLOWED PROPO D :RONT SIDE BEAR, FRONT U/R/IDE REAR
ALLOWED P..FO
PLIAN.E R
OM 0
COMPLIANCE OR
/0' Idlo loz/ A/4 Vlv
ADDITION COMMERCIAL CHANGE OF USE
0
PARKING I 3T AREA P N ING VIEWED By DATE
SIGN
2' REMODEL E] APARTMENT SIGN
REDD IfIlEl
FENC.
0 REPAIR X
ML CDS 0
RE --
REMARKS
DEMOLISH C] TANK o OTHER
�GAFtAGE L EAL
'�T
CARPORT
AR
p
t
TYPE OF USE. BUSINESS O'RAjRUrNL
-51p?a 9 1 -
!�_ �.CHECKED
FWII�r 1_74E�r,
NUMBER N TIRCAL W_
-L M9EROF OR
U
D Y
OF DWELLING AR
U NU
STORIES UN'T,
BE WORK TO BE DONE
-Cup-
BY UCT' DR.-
CTION C R3
JTYPE.�Tq
— ----- -----
2UBC I.W.
MSS INSPECTIONS PER 1081FINAL INSPECTION
6-n K�6r Pp�zK- A4�,--iV I, ov,4�pn-t-:l
VALUATION I FEE
'5�_
ECK FEE
RCI S�GFE
BULIING
40
PLAN CHECK NO: ESTED DATE
r
PLUMBING
nn- in MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
!=I BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
GRADINGIFILL
STATE SURCHARGE
PERMIT APPLICATI M 180 DAYS
PERMIT LIMIT.- I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENE. REVIEW FEES
-APPLICANT. ON BEHALF OF HIS ON HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
LL LANSFOR ANAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
A C D
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
0
, DEEMEDTO MODIFY.WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAYTHE ClTY'SABILITY TO ENFORCE ANYORDINANCE PROVISION.'
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
RECEIPT
RECEIPT
so
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATK G DNS Ruc
HE 0 4B ECE M P LCY E �
TION:ANDIN ONG THE WORK AUTHORIZED THEREBY. NO PERSON WILL
IN VIO LATION DIE THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 1B.27.
F T 0 E SIGNED
z:L 07L 11-2 Z5141
ArrENffON
IT IS UNLAWFUL.TO USE 08 OCCUPY A BUILDING 08 STRUCTURE UNTIL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
APPLICATION APPROVAL
b I �Iil ld by th.
CALL O.,puly' -d F .11 d. ,d
p- k,I�dg.� n sp prolid.d.
FOR INSPECTION
OFFICIALS S, NAT RE D TE
(425)
771-0220 ELEASED Y
EXT 333 //z 6ko
771-0221
ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL IN SPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD ASSESSOR
z
0
c m
M 0
0
0
c
m
m z
3:
rj)
0
mm
0
o
C (1)
M 0
Z r-
Z
--I
cl)
z
0
1
0
m