20000475.pdf1-4 DATE RECEIVED
. i
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE��
�ZEOFBW
MAILING ADDRESS
ko - V�, rix
CITY zlimPDT
Id'Inorl 8 9
NAME
ADDRESS
CITY ZIP TELEPHONE
_[PERMIT
EXPIREE j�&L
USE PERMIT
7�00'475
ZONE NUMBER
'06 S E`��q
ADDRESS
06 lnil& /-/z
FLAT NAM[USUBOIVISION NO,
LOT NO
I
Ll. FEE S
PUBLIC RIGHT 01 WAY PER OFFICIAL STREET MAI
EXISTING — PROPOSED —
REQUIRED DEDICATION— FT
NO. OF FIXTURES
PpV REQUIRED
YES 0 No 0
ARKS
OWNERIGONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY
DATE
;ITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADBII
INSPECTION-
0 Y RE 'D
ESOMNO
I BOND
1POSTEO
NUMBER
TATE —LICENSE
EXPIRATION
SERA REVIEIA
COMPLETE EXEMPT
EXP
SIGN ARSA
ALLOWED I PROPOSED
HEIGHT
ALLOWED , PROPOSED
T PARCEL NO.
0 NEW
PLUMBING I MECH
T COVERAGE
ALLGWED PROPOSED
REQUIRED SETBACK$ (FT3
FRON9 SIDE HEAR
PROPOSED SETBACKS (FT.)
FRONT UPSIDE PEAS
C] ADDITION
COMPLIANCE OR
CHANGE OF USE
I
PARKING
LOT AREA
P NING REVIEWED BY DATE
E] REMODEL
n SIGN
PEO" I PROVIDED
REPAIR
yDS 0 "ENCE X FT)
HIS
0 DEMOLISH
0 TANK
o OTHER
0 GARAGE 0 RETAININGWALL 0 RENEWAL
C5 ITT
ITIPE61 EXPLAIN:
CHECKED
f�QTION
0 CUPA
PC
JE� GC UP
NUMBE
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICA
AREAS
N MEER
U
PECIALINSPECTOR
REQUIRED r-I
JAREA OCCUPANI
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
— .. �Q Nv;zpp(lTInN-1 PFR UBC 1081FINAL INSPECTION REO'
VALUATION
FEE
PLAN CHECK FEE
LOT SLOPE Y,
BUILDING
PLAN CHECK NO: VESTED DATE
PLUMBING
-- -
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLRtC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS* MARQUEES, ETC.) WILL REQUJ E
SEPARATE PERMISSION4
STATE SURCHARGE
FE M IT APPLICATION; 180-AYS
PERMIT LIMM I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REV15W FEES
SEE BACK OF PINK PERMIT FDA MORE INFORMATION
POUS HEIRS, ASSIGNS AND SUCCESORS
ON BEHALF OF HIS OR HER S ET
ENO, INSPECTION PEE
;APPLICANT.
G
N N DEF AND HOLD HARMLESS THE CITY OF
NG' N� 'Fy'
:T A YA-
. 'ND'oAP'NG
MDERlSWT-=,lTQ`O
OMF F C,,AL,5
TLYFR..
I E m N" N. ET,�L�,�y,EES IIIIAGECN;T ORINDIR—L,
IHS.CTION FEE
ING RE
ALLCLAIMS FOR DAMAGES OF WHATE g,A
ISSUANCE OF THIS EF. T I5HALL NOT BE
P ]CITY
PLAN CHECK DEPOSIT
/5-612,
IS ISSUANCE OF THIS PERMIT,
I. .. T' LIS ORDINANCE
' ..O.,FY'WAI'E OR REDUCE ANY REG ENTOFANY
OEBME.
'OREM
D NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO EN CE ANY ORDINANCE PROVISION
PT
THAT' HAVE READTHIK APPLICATION; THAT THENFORMATION
APPLICATION APPROVAL
IHERE ACKNOWLEDGE NT OF
GIVENOY CORRECT. AND THAT I AM THE OWNER, OR T HE DULY AUTHORIZED AG:T
TIP, 1pPfIllt— 11 po 51,1d by thO
'O.P.Iy%.
THE OlYNER, I AGREE TO CO YANG STAT , LAWS RE ULAT. ON U
PL�"T C,
CALL
B"im', Offic., F..
HE ON WILL I
Aylg' Z'TE 3E EMPLOYE%
GTHE Y��.FFE
T'ON "'N"C"' RELATING TO
FOR INSPECTION
I-11I �p— Yd-
0 F THE STATE OF WASHINGTON
I. V�DLAT .oT
E AND FC. 1-21
IALS SIGNATURE DATE
W.NXME��-� CO.
OFFII
b
DATE SIGNED co
(425)
771-0220
RELEASED Y DATE
AT�(ENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION 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
sms
z
0
m
n
m
c:
m 00
0
m m
z
0
c)
0 -n,
n
m m
0
0
92
zo
A
z
m
0�
�S
0DAT7EREcetvED
[PE R�M�l T�E X P I R E
.4 US
Z9'NE
ZO
E P E R M IT
PERMIT zo
RE
ONDS
CITY OF EDMONDS
M B Ell
14UMBER
N U
CONSTRUCTION PERMIT APPLICATION JOB
A CATION A
PPL, ADDRESS
ED
DR 062 'i7-
06 Z " Lt
I OF ILK �'N
Y_
PI -AT NAME/SUBDIVISION NO.
OT No
LOT NO.
LI NO,
e
9
LID FEE S
.1
MAILING ADDRESS /
o?( s- 8 el
STREET m P
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EUXISTING PROPOSED
CITY
C?
E
PR�
E
U-5
REGUIREDDED;CATION— PT —
C)
METER SIZE
ET R SIZE
LIKE SIZE
LIKE SIZE
110*011IXTOR11
00 0, 'IxTLIRES
PIIV REQUIRED
NAME
I
YES C3 No 0
I
9
�el
ADDRESS
'4
FIRE REVIEWED By I , DATE
CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR AGE.
INSPECTI N
a
OYRE 0
ES ONO
BOND
POSTED
STATE LICENSE NUMBER
COMPLETE EXEMPT
I
SIGN AREA
ALLOWED PROPOSED
I
HEIGHT
ALLOWED PROPOSED
I
FR—OPERTY TAX ACTNT PARCEL NO.
(2) '00
s-06 0 66 - 003
EXI
LOT COVERAGE
REQUIRED SETBACKS IT
PROPOSED SETBACKS (FT.)
0 NEW 0 PLUMBING I MECH
ALLOWED PROPOSED
FRONT SIDE BEAR
FRONT URSIDE RE R
o COMPLIANCE OR
0 ADDITION CHANGE OF USE
PLANNING REVIEWED By DATE
0 REMODEL 0 SIGN
REO'D
I PROVIDED
"Y"S 0 111E
0 REPAIR ( X IT)
REMARKS
0 DEMOLISH TANK 0 OTHER
oGARAGE 0 RETAININGWALL 0 RENEWAL
CARPORT
(TYPE OF US E BUSINESS OR I _B!6"�XPILAINI
,
CHECKED BY
CTION
FANk7_
ROUP
'w 4 k,(\
� X
JTY��
I
NUMBER
N NIGER OF CRITICA
ABBAS
SPECIAL INSPECTOR
U
OF
STORIES
0 LUNG
UnE NUMBE R
REQU ISED
JAIIA ILOAD
DESOMIE WORK TO BE DONE __.E.ARKS
PER UBC 1081FINAL INSPECTION REG
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GILA ING I
LOT SLOPE %
BUILDING
PLAN CHECK NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED HIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY C614TSTRUCTION ON THE PUBLI C
GRADINGIFILL
DOMAIN SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.1 WILL REQUIRE
CURBS
I=
z SEPARATE PERMISSION.
STATE SURCHARGE
RMiT APPLICATION: 180 DAYS
PERMIT LIMIT'. I YEAPE. PROVIDED WORK IS STARTED WITHIN 180 DAYS
A
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND I OCSSORS
OF
ENO. INSPECTION FEE
t
INDEMNIFY, DEFEND AND HOL ML
IN INTE ST, AGREES OHA EBB THE CITY
BE To AGENTS FROM ANY AND
ANDSCAPING
FEE
i
EDMONDS . WASHINGTON, ITS=ALS, EMPLOYEES, AN
V DIRECTLYOR INDIRECTLY
'E' OF BIT NATURE ' ARISING
ALLCL"M' FOR DAMAO BE
I SPECTION
I
REG PT/,5'-6/1
12 0
. T. ISSUANCE OF THIS PERMIT SHIA
... THE ISSUANCE 01 THIS PER I LL NOT
PLAN CHECK DEPOSIT
GEE.E.'.MO"'y.A.E 08 REDD E ANY REOUISEMENT OF ANY CITYORDINANCE
TO ENFORCE ANY ORDINANCE PROVISION.
RECEIPT
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY
TOTAL AMOUNT DUE
I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORM AU
APpUCATION APPROVAL
IS CORREG THE DULY AUTHORIZED AGENT 01
GIVEN T. AND THAT I AM THE OWNER, OR 'WGRF.U'T'.G..IIET RUC -
1 ��Iil.fp.dby
CALL o8putMy:I&ndF,asa,ep.sd.a
FLY 'IT
THE OWNER. I AGREE TO GO T CITYANDSIAT�
0
AND IN DOING TH FK IT, "E. THEREBY NOPERS NINJILLSESAIPLOYED
TION UT TO
Bdld�q off,clat"�isl
FOR INSPECTION in spaco providod.
L F THE STATE 0 WASH] RELATING
IN F NGTON
VI bLATION OF T
�10
DATE
WORKMEN'S C NS cEANDR=1&27.
OFFICIALS SIGNATURE
ATE SIGNED
D CC)
9
Or& 09
(425)
-0220 E ly
771 RELEAS D
EXT 333
ATTENTION
ITIS UNLAWFULTO USE OR OCCUPYABUILDING 08 STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELL. - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PC- PINK - OWNER GOLD - ASSESSOR
5,98
Z
0
m
3:
M
In 00
80
c:
m 'T
ID -i
c
O.n
-n
rn In
0-
000
0 Fn
c ca
c ca
m 0
z
7,
z
(n
z
0
i
m