20000554.pdf"�F_ _—] — - ll—(
DATE RECEIVED FZ I PERMIT EXPIRES - .1
Us PERMIT
Zo E NUMBER
CITY OF EDMONDS
'U
CONSTRUCTION PERMIT APPLICATION 'AO080RESS hc L�� ITEIAPT,
US
FEDMONDS Zo
P
HE
P
N
E
U
R
M
M
EI
IT
ER
PPL'
-6
NO
N ER �A CATION 'A' DRESS
0
PI.AT NAMEISUBDIVISION NO, LOT NO, LID NO,
OWN ncAu LID FEE S
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER 0111CM1 STREET AAP P.,
P.— 4.1d
EXISTING — PROPOSED
CITY Z U
FE.UIREDDEGtCATION_ FT � -1, u.-
No OF 'IX'LRES PRV REOUIRED
NAME YES 0 NO 0
PC. RKS
IRE A
ADORE
CITY
NAME
w ADDRESS
0
ZIP
_Fh V'x
If A J
FIRE REVIEWED By DATE
CITY TE PHONE
760
VARIANCE OR CU SHORELINE OR AIDE. INSF
STATE LICENSE NUMBER 4 DATE CHECKED By
-1 10101
P
[3 YE
_SION�REA
j-X &_-9 `4 -- -' %
006
b
HEIGHT
PROP05EO
RCELNO.
'I PROPEPT`4,A�C
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED I
tIT
EXP I
LOTCOVERAGE REOUIRED SETBACKS (FT) PROPOSED SETBACKS FT)
�5g'.SIDENT-1 I
ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE FEAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
I
�WED By DATE
REMODEL C] APARTMENT C] SIGN
REDD I PROVIDED
REPAIR C] GRADING CYCS C] FENCE
X IT)
REMARKS
DEMOLISH TANK OTHER
GARAGE 0 RETAKIN RENEWAL
CARPORT Roe 'r WALL C]
(TYPE OF SINESS OR ACTIVITY) EXPI.AIN:
CHECKIDSY
TYP FCON
PAX�?
:;��G
GCGOUP
NUMBER
ER
NUMB OF
C RITICAL
�ECAL'�S"
SPECIAL%SlICTOR
AREA CCUPAHT
OF
I,
A EAS
Al SOURED YES
LOAD
M
0 STORIES
UnELLING
Np
UMBER
0
DESCRIBE WOR BE 0
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO
e) 2,0 1" -
HEAT S URCE GLAZING I
LOT SLOPE %
PLAN CHECK NO: IVESTED
DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
VOINLY.ANY..14STRUCTID.. T E PU LIC
T N
ILH RE05
%....'.,'O.PRSlV%T'.El.OPE.
CUR , EWALKS. DRIVEWAYS. MARQUEES, ETC.) W 1. LIFE
n SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
5 P I
PERMIT LIMIT. I YEAR - ROVIDED WORK S STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
IF AL'OF HIS on HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOPS
'L"'AEN�TjDA`.'EH
;A
NpNT . ES TO NCE.N' 011 HID AN. HOLD HARMLESS THE CITY 01
FY. E
2 EDMONOS.WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
E IRECTLY OR INDIRECTLY
A��IISFORO.AMAGESOFWHATEV R NATURE.ARISIN.0
NOT BE
A OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
YORDINANCE
OF ANY Cil
ORDINANCE PROVISION
I R EA 0 THIS APPLICATION. THAT THE INFORMATION
I A �E,'E S,
=TLEADNG.E T."ATT : A"AV
THE OWNER. ORATE, DULY�AUTIOTR'I�IIED AGENT 01
01% S
ET LA. E.ULA CONS R
OWNER. I AGREE TO COMPLY WITH CITY AND -
LO 'UE%
THE E M P
TION� AND IN DOING THE WORK AUTHORIZED THEREBY . NO PERSON WILL BE 0
RELATING T
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 1827.
I E.2
ZZ
(%D1111E
,_",\ c
2
VALUATION FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
I'D
-3� S RCHARGE
END REVIEW FEES
ENG. INSPECT ION FEE
LANDSCAPING
NSPECTION PEE
RECEIPT
PLAN CHECK DEPOSIT
RECEIPT f
TOTAL AMOUNT DUE
,PPROVAL
,l 119 Ih.
CALL
B..P.19 Offil ol h�' D.,ul, — F ,
FOR INSPECTION .-.,,,,�.�k�..I.dl.dl�,p.cop,o�ldad
OFFICI S SIGNATU E DA E
(425)
1 /
771-0220
61 "1
R LEASEDBY DATE I
1
1113
ATT�hTION r-A 1 0
IT IS UNLAW FULTo USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 ORIGINAL - FILE YELLOW INSPECTOR
A FINAL I NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBc SECTION 109 FAX
Z
m
c m
IT, a
0
80
c
-i L-
x m
M:�
10
—z
o -n
n
M
a
0
0
C:
z I
;u
z
0
.:1
0
m
DATERECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
MAILING ADDRESS
C3 ADDITION
REMODEL
REPAIR
DEMOLISH
0 GA AGE
CARPORT
DESCRIBE
HIN
"l-)5_151
ZIP
JO Fp _E�M717TEXPIFIES
USE PERMIT v
,ONE ssl
NUMBER 'ut
JOB UITVAPTN
ADDRESS 0
I �:� h,- S
PI -AT NAMEISUBDIVISION LOT NO* LID NO,
LID ESE S
P
PUBLIC RIGHT .1 WAY PER OFFICIAL STREET MAP TIIScF'"pm.d 0
D
EXISTING � PROPOSED 0
..qd 13
REQUIRED DEDICATION— FT
W111--l'.. C3
IFV REQUIRED
YESE3 No 0
REMARKS
lW11111111PACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
jtll�'Plj
f " i" 9 1 �if "
— '
ENGINEERING
lu -0
, R
RE�IIEIW
FIRE REVIEWED BY
DATE
z
J!
VARIANCE OR CU
SHORELINE OR ADS.
INSPFE_C_�_110_N BO D
KED BY
C
EQC
0 YES 13 NO
F 0 TED
SERA REVIEW
COMPLETE EXEMPT
I
SIGN AREA
ALLO WED I PROPOSED
HEIGHT
ALLOW 0 PROPOSED
T PARCEL NO.
-02
EXP .
m
M
-10ENTAL PL ... IN- I E-H
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS "T'
FRONT SIDE FEAR
PROPOSED SETBACKS I R�l
FRONT US SIDE RE
1
0
COMMERCIAL ci C MPLIANCE OR
1 8 0
C
PARKING
LOT AS
ED By DATE
CHANGE OF USE
--I c
APARTMENT El SIGN
REO'D PROVIDED
3: m
I
mz
PENCE
X X "I
REMARKS
0 TANK OTHER
>
1 11TAININGWALL RENEWAL
3 ROCKER,
C9
0 -n
_n
�S OR ACTIVITY) EXPLAIN:
CHECKEDBY
GNSTZ)Id
OCCOU
ITY
Up
12!�
rn rn
N EA OF
LIMB
CRI AL
SAG
S ECI JAREA
f OCCUPANT
U LONG
OWE
NITS
A
NUMBS R
6 RLINSPECTOR
JA
REG C] YES
iE
0
0
0 m
a 0)
%r'N�E no
REMARKS ... nON REO'D
PROGRESS INSPECTIONS PER LIBC 108/FINAL c (A
M 0
vap 4A 4
7-1
z
VALUATION FEE
ED THIS
PLAN CHECK FEE
z
9
GLAZING %
LOT SLOPE 1
BUILDING
�fRCE
IVEITEO
0
m
PLAN CHECK NO:
DATE
PLUMBING
PERMIT COVERS WORK TO
MECHANICAL
rp
I THIS PERMIT AUTHORIZES ONLY THE WORK NOT .
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
WAY MARQUEES, ETC.) WILL REGUIRE
DOMAIN (CURBS. SIDEWALKS, DRIVE S.
SEPARATE PERMISSION.
vo
t
P R IT APPLICATION: DAYS
E M
S RCHARGE
IT P K 1�100
PERMIT LIMIT'. I YEA , ROVIDEDWOR STARTED WITHIN III0 DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO, INSPEC ION FEE
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT.
N NTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
N.1
LANDSCAPING
INSPECTION PEE
ALLCLAIMSFOR DAMAGES OF WHATEVER NATURE. A ISING DIRECTO ......
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE 01 THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMEN r OF ANYCITY ORDINANCE -
NOR LIMIT IN ANYWAY THE CITY'S ABILITY 0 ENFORCE ANY ORDINANCE IROIISION.
T= T
RECEIPT
I "
TOTAL A ... NT DUE
/'
v
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
N' 1 . p7l'u" 'K."
TH9OWNER IAGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
PLOYTE D
CALL i
lu,ldl�D Olit—I .1 hi —I D.Puty: — F... — d.
TION; AND IN DOING THE WORK AUTHORIZED THE REBY. NO PERSON WILL B E
.6 ATING 0
FOR INSPE�-nON
iptil 11—wild9ldillp— P1111d.d.
LEM
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27
Ls SIGNATUfE
ITE
-7
(4:25)
771-6220
R _E�SEDEIY DATE
ATTENTION
EXT 333
08 STRUCTURE UNTIL
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL -FILE YELLOW INSPECTOR
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
v", FAX
PINK -OWNER GOLD -ASSESSOR
CATE
S`9.