20000307.pdfPERMIT EXPIRES
US, PERMIT R00307
ZONE
CITY OF EDMONDS
Ps NUMBER
JOB SUITEIAPT0I
ADDRESS
CONSTRUCTION PERMIT APPLICATION
nd td
OWNER N4MEI"lMl 01 BUSINESS
FIAT N�.STSU..WISION No.
-54
LOT NO.
LID NO.
C I"
LID FEES fff—
MAILING AO011Sl
---
TESCP Appl-d
-76,,Irl '4
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
P50UISED DEDICATION FT
- lIonnt ronw"PI
Innnnu.. Z.
R."""'
R11.d . 0
Uwll%lP,d
CITY ZIP
TELEPHONE
7
METER SIZE
S;ZEI
No�ff`T URES
PRY QUIRED
NAME
Y. NO
ADDRESS
REMARKS
OWNERICONTRACTOR
RESPONSIBLE
FOR EROSION CONTROUDRAINAGE
-/--3
CITY ZIP TELEPHONE
NAME
Ho m r,; n; la, t'l 1 14" NGINEEPING
ADDRESS
p" FIRE REVIEWED BY
CITY
ESSO,I
ZIP
TELEPHONE
�PATE A
VAT
BE NUMBER
t,ApjRuN DATE
CHSCKEDB
116MI55 N176P-9
CY
01. ILI 1 1:2 X
,
PROPERTY TAX ACCOUNT PARCEL NO
COME, I
Exp_
ILE
2<W
(Pf RESIDENTIAL
Ea_"PllJ.SIN. I IMEC.
ALLOIII
ADDITION
[0
0 COMMERCIAL
0 COMPLIANCE OR
CHANGE OF USE
0 REMODEL
APARTMENT
0 SIGN
RECro
0 REPAIR
G 'I
= GYUS 0 FENCE
CY.1 I ITI
0 DEMOLISH
C] TAhK
El OF..
Sy6ARA.E
RETAINING WALL
0
0 RENEWAL
CARPORT
ITIVI Y)EXPLMN
,)s �, 3
EVtEWSOIDATE
91, - 71- 4?
DATE
EX S MET ALLOWED 7-
m I gPRlo/lp Ig
ERAGE REOUIRED SETBACKS EFLI PH.I.SEI)SETIMICISIAll
PROPOSED T S DE ,, REIA.CR FRONT RE R
ITYPE OF USE, BUSIN " _ - CHECKED By TYPE 0 CO STRUCTIO A'G
T
U'
ROL
L
CRITI-1
,S
NUMBER NiERC, / SPECIAL INSPECTOR
OF D W ELLING, AREAS R A.
STORIES uN' To NuMBE
DESCRIBE IN TAX TO BE DON REMARKS
rI P
tr kbill Wond ba_" ROGRESS INSPECTIONS PER UBC, 1081FINAL INSPEI
A 5W�J_F li)&Z
I 114--'A Ir- a�O 1 41=�-) 11
PLAN CHECK FEE
So CE GL AZING LIT7
BUILDING
'et
PLAN CHECK NO: VESTEDOATE
PLUMBING
a ) L7 z ,
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 (CURD5, SIDEWALKS, DRIVEWAYS, MARQUEES� 61C.) WILL RED E
SEPARATE PERMISSION.
STATE SURCHARGE
PER ITAPPLICATI N: 100AYS
PERMIT LIMIlr I YEAR. PROVIDED WORK IS STARTED WITHIN ISO DAYS
END, REVIEW FEES
SEE BACK 01 PINK PERMIT FOR MORE INFORMATION
'APPUCANT� ON BEHALF OF HIS OR HE. SPOUSE. HEIRS. ASSIGNS N SU ES S
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HAR LESSTHECITY F
ANYAND
(I
�AIONOS WASHINGTON� ITS OFF$CTALS� EMPLOYEES, AND AD NTS F
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIR TLY INDIRt—,
INSEEGDo"EE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL HOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
PROIISION,'
NO" LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
I I TIE RE Try ACKNOWLE WE THAT: RAVRRE.AD THIS. AIPLI.CEATIULN� TAHAT IR E INFORMATION
AGENT OF
GIVFN tSCCFRECT.AHDT.AT AM T , WHE OR T G UTHoRIZED
REGULATING CONSTRUC
CALL
I I CITY AND STATE LAWS
NOT IA"ECTOCOMPLYWIT
THEREBY, NO PERSON WILL BE EMPLOYED
T:IEQ
ON, AND IN DOING THE WORK AUIHo'qIZED
IN VIOLA ION or THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTII
WORKMEN 5 COMFENEATION INSURANCE AND ACW 16,27
SIGNATURE (OWNER OR A
GATP SIGNED
(425)
771-0220
AITENTION
EXT 333
IT 19-UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECTION 109
FAX
5`98
z
m
mo
0
80
c
-49
mm
MO
0,
m M
0
0
M 0
Z
z
_q
m
0
z
0
q
0
m
by 11,
Thil M not - P-Inol ont"T"" . .in no
Building OjEciol . hi,nth.� D�pdly: no F .
Ino.
ipt I, no now o go 11
FFII tSIG HE t (ATE
4
EL DBY DATE
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK OWNER - GOLD - ASSESSOR
VALUATION
'S
PER�MIT EXPI E ��
PERMIT
2.003071/.
U. NUMBER
CITY OF EDMONDS Z IIE
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
'�2'el'l lid id.
OWNER NAMEINAME OF EU LOT NO. LID NO�
ENdESS PLAT NAMIUSUBDIVISION NO.
LID FEES &A —
MAILING AOIlR EIS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET .0
'd '4 6to.
EXISTING PROPOSED
CITY ZIP ITELIPHONE REQUIRED DEDICATION f_ IT
)5'clt 2),,,, n (�12A 7--)i'l,- _Z�_I� — I I.RE�
NAME MET;, LINE SIZE NO�OF XTURES
REMARKS
ADDRESS OWNERICONTRACTOR PEEP NSflBLE FOR EROSION CONTROLIDRAINAGE -/C-�,
CITY 'zip TELEPHONE 'L7
"'p
NAME 1 V
ADDRESS
IRE REVIEWED BY DATE
Fq
CITY
C.In -)4_4 (vw�l VARIA CEPR UN OR OBI S OTION BOND
Pee%o
S E LICENSE NUMBER S ONO
hom 15,5 N r'o oe r- F of /;zo SEPAREVIEW SKINI AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOW PROPO ED
Ex
AGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT RSl E'REAR
RESIDENTIAL ER"'PLUM.I. I ME.. ALLOWED PROPOSED
lREAR
p<VY
COMPLIANCE OR
C] ADDITION 0 COMMERCIAL CHANGE OF USE
PARKING LOT REA
0 REMODEL 0 APARTMENT 0 SIGN FtE;��Il
E] IENCE
0 REPAIR, G I CYDS X ITI REMARKS
o OTHER
0 DEMOLISH TANK
VARAGE
RE
CA 0 TI.TAIININD WALL RENEWAL
CARPORT 0, ER
2 _TrTpE GF USE, XPLAIN
BUSINESS ? CHECKED BY TYPE 0 0 STRUCTION GO
n�Y�Tt 3/01
UPANT
Id NUMBER SP Cl L NSPECTOR AD
OF RE U HE
DYES
o STORIES
DESCRIBEW RK TO BE DON
o
IT REMA
GRESS INSPECTIONS PER UBC 108MNAL INSPECTION REQ
RORKE -0
Fill
tv i4j, a$3 Chld
-A Con 10222cl p=b -
VALUATION
PLAN CHECK FEE
S P
HEAT S URCE GLAZING % LOT
BUILDING
uat&I VESTED DATE
PLAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK N011RM THIS PERMIT COVERS WORK TO
d BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
GRADINGIFILL
DOMAIN (CURBS. SIDEWA LKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
STATE SURCHARGE
SEPARATE PERMISSION.
PE MIT.PPLICATION; 1800AYS
I
PERMIT LIMIT. I YEAR � PROVIDED WORK S STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
-AF�LICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
HARMLESS THE CITY OF
ENG, INSPECTION FEE
(0,I
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD
ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
LwoscAq=
iNsPFCTION-FEE '�—
2 EDMONDS� WASHINGTON,
SOFWHATEVER NATURE, ARISING DIRECT
ALLCLAIMS FOR DAMAGE LYORINDIRECTLY
R
FRO. THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANYCITY ORDINANCE
R
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PH—S—,
TOTAL AMOUNT DUE
IHEAE Y ACKNOWLEDGE THAT I HAVE READ THIS AppT�C�AUL ,ATTREl.N.1ORlI I.N
V 'Z AGENTOF
OR G
GIVEN" IS CORRECT. AND THAT I AM THE OWNER. ALTH.
REGULATING CONSTRUC -
CALL
r THEOWNER I AGREE TOCOMPLY WITH CITY AND STATE LAWS
THEREBY, NO PERSON WILL BE
TION, AND IN DOING THE WORK AUT80RIZED EMPLOYED
LABOR CODE OF THE STATE OF WASHINGTON RE ATING TO
FOR INSPECTION
IN VIOLATION OF THE
Wop KNIEN S COMPENSATION INS�A E AND RCW 182 7.
�g
(425)
1 771-0220
EXT 333
Ai�ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI,
A FINAL
HAS BEEN GRANTED. UBG SECTION 109
FAX
CATE OF OCCUPANCY
APPLICATION APPROVAL
Tha IPPI'llfila il 1 - POInal an",sTs" "Y""o
,ng oll,q dfiIo,DePun, and a 1110 -Y!,nd
ORIGINAL -FILE - YELLOW- INSPECTOR
PINK OWNER- GOLD -ASSESSOR
z
0
0
a m
c
mo
0
80
c
--I C
x M
6
0 -n
n
rn m
I
0
C rA
m C.7
M 0
X
z
--I
m
z
9
0