20000360.pdf13ATERE.11VID
PERMIT EXPIRES
USE PERMIT .2 cyc' 0
CITY OF EDMONDS ZONE NUMBER SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION JOB
ADORE S
S �I� q - 23 1A)
OWNE NAMEMAMSOF BUSINESS PLAT NAM11SUBDIVISION NO
LOT NO. LID NO.
s: -15G
2- LID FEE S
A�1— e-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET M11
MAILING ADDRESS p, 111.1%44v� 0
3 " PROPOSED —
EXISTING . A ...... . ...
CITY ZIP TELER ... E U.—
REOUIREDDEDICATiON FT
SIZE No. OF FIXTURES ps QUIRE.
STEP SIZE
LINE
'Es NO 0
1,
NAME
n-,-y UA
REMARKS
1
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR SHU-1 NTROUDRA,INAGE
TELEPHONE 4)
CIT
NAME 'IDA
ENGINEERING
ADDRESS
Q FIRE REVIEWED By ic
z
11LERHI ONE
cl Y I
0 IV6 VARIANCE OR CU SHORELINE OR AOSN IN BOND IT
S
CHE K Da
STATE LICENSE NU BER [3Y 5 0 0
c17 HEIGHT
SIGN AREA
SERA REW A O.E. ALLOWED PROPOSED
COMPLETE EXEMPT LLOWED P 0
-6
vi
PROPERTY TAX ACCOUNT PARCEL NO�
-00 EXP
RE REDSETEI KS (FT.) PROPOSEDSETBACKS �FT
REAR
M
10
LOT COVERAGE
KNEW RESIDENTIAL PLUMBING t MECH ALL OWED PROPOSED 7 SIDE REAR FRONT U ,ICE
7'
m
o COMPLIA CEOR -?;�
0 ADDITION 0 COMMERCIAL CHANGE OF USE PARKING LOT AR A P EWEDBY DATE
C:
-4 L-
x rn
0 REMODEL C3 APARTMENT 0 SIGN ASCII) PROVIDED
M Z
jo -4
FENCE AN S
C3 REPAIR am CYDS 0 1 — X FT)
0 DEMOLISH 0 TANK o OTHER
IC GARAGE C3 RETAINING WALL 0 RENEWAL
0 -n
, CARPORT E 0 CUPANT
0 CHECKEDBY TYR CO STRUCTION GO
(TYPE OF US BUS111111I Po P
NUMBER
CRITICAL A AREA OCOU NT
6 AREAS SPECIAL INSPE LOAD
REQUIRED
m m
a FA
OF
DWELL 0 YES
U ITS NUMBER
[ES
STORIES z
DESCRIBE WORK TO BE DONE REMARKS ECTION REO'D 9
INSPECTIONS PER USC JOBIFINAL INSP
C: 0)
m ca
PROGRESS 5
A11=7j)
z
'Ind
Is—
VALUATION FEE
PLAN CHECK FEE
(o
HEAT SOURCE GLAZING % L OPE- BUILDING
0
m
VESTED DATE PL MBING
PLAN CHECK NO:
3 MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PEAMITICOVHEERS WORK TO 1D
0 NLY. ANY CONSTRUCTION PU LIC GRADINGfFILL
COE DONE ON PRIVATE PROPERTY
S, MARQUEES, E CTWILLREOUtRE
OMAIN CURBS. SIDEWALKS, ORIVENERMISSIOM
Ay
3 SEPARATE STATE SURCHARGE
'50
2 PERMIT APPLICATION: 180 DAYS
WORK IS STARTED WITHIN 160 DAYS ENG. REVIEW FEES
PERMIT LIMIT'. I YEAR AOVIDED M
SEE BACK OF PINK PERMITFOR OREINFORMATION
FEE
ENG, INSPECTION
IS OR HER SpOU$9� HEIRS. ASSIGNS AND SUCCESORS
H G
-AP PL"`ANTjoNSEHAL F OF P, DEFEND AND HOLD HARMLESS THE CITY OF
A S TO IN.EMNI NO E
"A'
NTERES
IN I ' 'TTL`,'O'�'M RE-11
2 EDMONDS. WASHINGTON, ITSCPF1TC,1VLSo EAMTUoy`A`,rjA,,N.G EEO N�A,.ECTLY
A BE
ALL I $F PDAMAGES IS PERMIT SHALL NOT PLAN CHECK DEPOSIT
FRO THE I SUA E F THIS PEA IT' ISSUAENCEISOEMFETNTOr ANY CITY ORDINANCE
RREDUL A
All E EANY Delp
EEMED Cot Y, G,
T ENFORCEA Y ROINANCEPROVISIOM-
ITY'SABI ITY TO DUE
IT ANY AYT TOTAL AMOUNT
N APPLICATION APPROVAL
T THE"'FORMA'"
E OR D AUTHO ZED ACE pj ,I,] 11g— by 11,.
I ITEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUICEAT'ULN�THA A NT OF PPk-I1—,�jhe,'O,puty'8bd Foes -d
T ATIA HE N STAUC-hi
C CALL
AND Build,19 oil,_-
GIVEN 'RE3AFE STATE LAWS REGULATING CON �kl.dg.d —0-- P—d.,I�
IS COR ITH ITYAN
THEOWNEIT AiCT TOO PLY YNoPERS N LLSEEMPLOYTED —Pt—
RIZSDE HE E B
0 FOR INSPECTION
110 IN RKAUTH DATE
TH! DE F TH STAT E WASHINGTON RELATING
01
DC�NGIHE �A. A OFFICI SIG U
�OLATt
KMEN�"; OPENSATIO SURANCE AND PC 18,27.
0 OR"p
'D (425)
DATE SIG 771-0220 IIE,7
c—
---7-r--/ EXT 333
ENTION
OR STRUCTURE UNTIL
YELLOW. NS—TOR
IT IS UNLAWFULTO USIOR OCCUPY ABUILDING ORIGINAL FILE
EN MADE AND APPROVAL OR A CERTIFI
PINK ASSESSOR
OWNER GOLD
JE
)W HAS B EE
A FINAL INSPECTION HA
BEEN GRANTED. UBC SECTION 109 FAX
CATE OF OCCUPANCY HAS
PERMIT EXPI91' 'S
PERMIT
CITY OF EDMONDS ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION JAODBORESS
E.17"Alo
DIANE NAMEINAME OF BU INESS
FLA�EMEISTjIVJSJ�.NN� LOT Nj..
III) NO,
P-rx icP�LJ_IR
LID�FEE S
MAILING ADD ESE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
App—d I.d. qV. 0.
0 .01
32
CITY ZIP
TELEPHONE
XISTING EROPOSEO�
B.— � Bl�
UMsMI..d
�9628
X,�
REQUIRED DEDICATION FT —
...d (3
METER SIZE
� LINE IIIE NO* OF FIXTURES
IFI FECUJIFEG
YES No 0
NIME'
N
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
_097-7,�WE-571
ADDRESS
'-S 0
CITY III
TELEPHONE
NAME
INC,
IF-1 LJA�
10INEERING,/
A7E�,, 40;�_
FIRE REVIEWED BY DATE
CIT ZIP TELEPHONE
a:
Z
0 6619006
0
d
VARIANCE OR CU
I SHORELINE OR AU.s
0
0
STATE LICENSE NUMBER DATE
F u _y
e1A) t,,3
T.
SERA REVIEW
SIGN AH"A
HEIGHT
PROPOSED
COMPLETE I E�XW�MpTALLOW�EGPROPOEED
ALLO ED
Zfl
TAX ACCD�UNT ADEL NO.
m
c
RESIDENTIAL PLUMBING I MECH
LOT COVERAGE
A�� PROPOSED
RECUR
FRONT BOB REA"
T I�SIDE REAR 0
IROITIk 1171
COMPLIANCE OR
m
0
C] ADDITION COMMERCIAL 0 CHANGE 01 USE
8
PARKING
REDID PROVIDE
LOT AREA
P A EWEDBY DATE
REMO�EL C] APARTMENT E] SIGN
c:
:� m
FENCE
REPAIR CYDS 0 ( — X FT)
m
REMARKS
0 DEMOLISH 0 TANK ci OTHER
GARAGE RETAINING WILL RENEWAL
CA2 OR RO.�Ry C]
4F
V)
0 -n
0
FEUS—ETOUSINESS.CI3�Ill���T1.11-1-�I
STRUCTION
E OCCUPANT
CHECKED BY
GROUP
I
M m
NUMBER NUMBER OF
C METAIC
SPECIAL INSPE OTOR
OF DWELLING
STORIES I
Al S
NUMBER
REOUIRED [3 YES
JARIA
LOAD
1j;t5e. .
50e
0
6
0
WORK TO BE GONE
DESCRIBE
REMARKS PECTION REQ'D
PROGRESS INSPECT106 S PER UBC 108fFINA S
Cc: m
U)
9 ri)
CQ&�MCT MEW '_51AXU:-_
A
MO
7-1
Z�
W-50
-7
&m ',"v&f6 -
z
VALUATIO FEE
&A 5z
50
PI -AN CHECK FEE
z
0
HEAT SOURCE LWP3!%2,.
BUILDING
I
0
PLAN CHECK NO: VESTED DATE
PLUMBING
m
(Tcv I Q �-3 —
CCHAlICAl
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
ON Th P BUC
llq0
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION
DOMAIN (CLASS. RI WAYS, MARQUEES, ETC.) WILLREQUIll'ECE
SIDEWALKS. D VE
GRADINGIFILL
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMITUMIT.- I YEAR - PROVIDED WORK IS STARTED WITHIN VIDDAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FDA MORE INFORMATION
FEE oizI
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
AGREES T INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
13 0
ENG, INSPECTION
G 51
IN INTEREST,
S,,MOND,,WASHINGTOII,I.TFtWOI�FlllAlr. EMPLOYEES, AND AGENTS FROM ANY AND
E
LLCL". '.R.AMAGE ATEVER NATURE. ARISING DIRECTLY 0 RINDIRECTLY
A PERMIT SHALL NOT BE
RECE, T
� s-.
FROM THE ISSUANCE .1 THIS PERMIT, ISSUANCE OF THIS
DEEMED TO MODIFY, WAIVE OR REDUCEANY REGUIREMENTOF ANY CITY ORDINANCE
SION,�
PROVISION,�
ECEIR
NOR LIMIT IN ANY WAYTHE CITY'SABILITY TOENFORCE ANYORDINANCE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE ME RMATION
IAPPROVAL
141--310t
P
GIVEN I CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
jc� os,00,s psoo,I Iool s,p.o b,
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL E.,Th..Pip
oo, Ojj,o.I .1 N.1hol Dop,ly: old Foes — p1ld. od�
NON; AND IN DOING THEW RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION ,,.,p, , ,kt0d9ld 11 so... p—dod.
IN IN LATION OF THE LAB R CODE OF THE STATE OF
WORKOMEN'S COMPENSATION INSURANCF AND RCW 18.27.
ED
0 T RE DATE
(425)
I STGNATV E�O N OR G
-�3 4 -
771-0220 REL ATE
.
ATTENTION
EXT 333 A)
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
GRID TOR
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109
FAX PINK -OWNER GOLD -ASSESSOR
�198