20000565.pdfqL
D=I_l 1(_)C)
[Fo__
RMIT EXPIRES
2L
0
us
PERMIT
OFEDMONDS
CITY OF EDMONDS
E
ZONE
Zo N
NUMBER
'CATION
APPLICATION
APPL
a
JOB
jo
PT,
ON PERMIT
CONSTRUCTION PERMIT
A"
'D
ADDRESS
22
OVVPNAMENAME OF BUSINESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LI NO.
6 �, c� h4 a P,
UD FEE
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER .11ICIAl
PUE
STREET MAP
1ESCPAPP—d
P-1 0
0
z, Pq
cl ZIP
E
EXISTING — PROPOSED—
EX'
0
_A,_�Af
�51_EPHO
6,7 J13
R IOUIRED DEDICATION —
IT
gh
_V
z?s
METER SIZE
LINE SIZE
FRV REQUIRED
NAME
I
YES I N.
ADDRESS
REMARKS
=1111—NTRACTOR
RESPONSIBLE
FOR EROSION CONTPOLJBIAIN�._
5
I I FiNTY - ZIP I TELEPHONE
X. ADDRESS/
FIRE REVIEWED By
FIRE REVIEWED By
DATE
CITY
ZIP
TELEPHONE
c
VARIANCE OR CU SHORELINE OR ADBN
V.AfllANC. OR CL
INSPECTION
BOND
_SiWfE LICENSE NUMBER
ATE
PIRATI.N DATE
CHECKED BY
PEO.,
"YES ONO
STEC
1p
SERA REVIEW SIGN AREA
BE A REVIEW
EXEMPT ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT
PARCEL NO.
OMPLETE
,
(7
EXP
-TROPOSED
LOT COVERAGE REQUIRED SETBACKS (PT.
SETBACKS IF T
E?.EW
'SDE"TA'
PL .. IN. I IVECIA
ALL OWED PROPOSED FRONT SIDE REAR
REA
FRONT LIR SIDE R
cl ADDIT G"
[c]
(3 ... ERC IAL
cl C..�LIANC OR
CHANGE OF USE
PARKING
LOT AREA PLANNING REVIEWED DATE
REMODEL
0 ARA T.ENT
SIGN
REDD I IROV,D�
GRADING
F��PE
EMARKS
REPAIR
0 YDS
FTI
C] DEMOLISH
C] TANK
OTHER
G ARA E
Cl.PG.RT
0 FTAININYG WALL
FOCKER
0 RENEWAL
TYPE OFUSE.. 8 SINES R ACTIVI�,T
of
C
0 CUPA
ZY)PLAIN'
L9 it--
C
GROUP
UMBER
NUMBER OF
NUMBER 0
F,T�
C
CRITICAL
OCCUPANT
OF
LL,NQ
DWE LING
DWEt
A EAS
AREAE
RED
REQUIRED YES
YES
LOAD
STORIES L_
2
U NITS
NUMBER
NU�MBJ
[3
[3
-DESCRIBE WORK TO BE DONE
REMARKS
ENIARK
Qq IfJqPFf'TIONS PER UBC 1081FINAL INSPECTION REG
VALUATION
PLAN CHECK FEE
�S URCE GLAZING I
BUILDING
PLAN C ECK N VESTED DATE
PLUMBING
g� (-) (o
MECHANICAt-
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E,.,Ul RgIVAT E P. . PER T I . INLY. ANY C . IN ST R UCTION ON THE PUBLIC
WILL REQUIRE
GRADINGIFILL
BE M�g
N C . SIDEWALKS, DRIVEWAY% MARQUEES. ETC.)
SEPARATE PERMISSION,
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
P ED WORK IS STARTED WITHIN 180 DAYS
PERMIT LIMIT: I YEAR ROVID
ENG REVIEW FEES
I; M
SEE BACK 0 PINK PERMIT FOR MORE INFOR ATION
ww ON BEHALF F HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT
N INTEREST. AGREES T :NDEMNIFY. DEFEND AND AOLD HARMLESS THE CITY OF
AND AGENTS FROM ANYAND
Ll
FEE
Z TSOFFICIALS. EMPLOYEES,
E MOND$, WASHING1 ON-
INSPECTION
REC,
OFWHATEIER NATURE. ARISING
AD R DAMAGES IS FERMI F SHALL NOT BE
F OF THIS PERMIT. ISSUANCE .1 THIS
PLAN CHECK DEPOSIT
2-(o
F ANY CITY ORDINANCE
RDINANCE PROVISION.'
R P
TOTAL AMOUNT DUE
READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
THERE ACKNOWLEDGE THAT I HAVE
By AND THAT I AM THE A THE DULY AUTHOR ED AGENT OF
Thl-ppi-11-1 11 - a PO-1 `�I'
COWNER
GIVEN CORRECT. S -
THCOWS11 IAGR ETOCOMPLYWITH IT TATE LAWS REGULATING CONSTRUC
YAN60
C ALL
BL'K, 01,1 o, limll,.; D.P.1y. -�d F P,
TI.N; AND IN DING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION ,,,.pt,, 1� 0 90d 11 P.. 0-
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S C SATION INSURANCE AND CW 18.27.
OFF I ILS SIGNATURE DATE
-:& `7
DATE lIGNE
(425)
1 .
,
771-0220
�x t kfA�tLl
ELEASED5Y DATE
EXT1333
—7
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPYA BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
IIIINAL - 'ILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PIN� OWNER - GOLD - ASSESSOR
5198
z
0
m
o rn C
c: a
rn 0
'o
0 C=
I m
m z
JD --I
0 -n
In
-4
m M
0
Fn
(j)
co
M 0
Z r-
7-1 W
;u
z
z
9
0
m
OF4
RECORD OF INSPECTIONS
z
am I
a
ma
m
Mz
nx
mm
a
0-
0
c
m 0
z
z
rn
TE RICEIVT
0
PERMIT EXPIRES
..
PERMIT
P
CITY OF EDMONDS
Zo
ZONE
M E
NUMBER
N
CONSTRUCTION PERMIT APPLICATION
6
'A'D'DFESS
'o AD' P
D E'
Z
011,11 NAMEINAMIOF BUSINESS
PLA
40.
6 Da e
It)
:EE S
MAILING ADDRESS
d
"A 1— 0
ERGFF.I A
US " 'GHT - W Y P C L RE
P L ST
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 4;"P.4ft R.quY.d
R
l....Pld 0
2 2/L 2 2
CITY TEIEPII.�E
7FA
XISTING— PROPOSED—
EXISTING — PROP SED — ...... cl
S -7
RE 'G ION_
REQUIRED DEDICATION—
IT u..
IT 1.1-d
E E
T R EIZ
N OF FIXTURES PRV REQUIRED
NAME
YES 0 NO 13
ADDRESIZ
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIUMAIN'll 1.
CITY ZIP JTELEPH�NE
%
FIRE REVIEWED BY
DATE
CITY ZIP TELEPHONE
VARIANCE OR CU
SHORELINE OR ADB� PEC BOND.
'Nlll�. 7D'ON
STATE LICENSE NUMBER EXPIRATION DATE CHECKED5Y
P.ETE
OYES ONO
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REWEW
COMPLETE EXEMPT
SIGN AREA HEIGHT. I
ALLOWED PROPOSED ALLOWED PROPOSED
oc)7 00
LOT COVERAGE REQUIRED SETBACKS (FT -I PROPOSED SETBACKS (FT.)
C] NEW [gRESIDENTIAL C] PLUMBING / MECH
ALLOWED PROPOSED
FRONT SIDE HEAR FRONT UP SIDE REAR
AL
C] ADDITION El COMMEACI COMPLIANCE OR
CHANGE OF USE
PARKING —11A
PLANNING REVIEW E_�IIYDATE
REMODEL APARTMENT SIGN
REO'D I PROVIDED
C] FENCE
REPAIR 0 GRADING GYDE X ITI
X
C] DEMOLISH TANK OTHER
GARAGE RETAIN G WALL RENEWAL
CARPORT C] ROGXE2L 0
(TYPE OF,USE. B SINESS OR ACTIVITY)AXPLAIN: CCUPA
ION
CM
f"t
ITYPEO
ROLF 2
N MSE OF CRITICAl
R IT E
NUMBER R t.I AREAS
tA.A.
SPECIAL INn. 0 CURANT
0
D ELLI NO
OF 2 U. R
STORIES UNITS I
REQUIRED YES JAIIEA
JOG
LOI-
DESCRIBE WORK TO BE DONE REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RED'
17,c 1t�
W, , _U�itlp!N
FEE
H SOURCE GLAZING
0
15c)
DATE
PLAN C ECK N
PLUMBING
IVESTED
THIS PERMIT AUTHORIZES ONLY THE WORK NOTE.. THIS PERMIT COVERS WORK TO
MECHANICAL
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
IS DOMAIN (CURBS SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
I: STATE SURCHARGE
P RMITAPPLICATI N; ISO DAYS
E
PERMIT LIMIT: I YEAR - ROVIDED WORK IS STARTED WITHIN ISO DAYS
P
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OQl
LICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCE 0 S
;AP
ESS THE CITY OF IN
N INTEREST. AGREES TO ;NDEMNIFY, DEFEND AND HOLD HARML LANDStAP G
2 EDMONDS. WASHINGTON. TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
AU FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLIOR INDIRECTLY
INSPECTION FEE
RECEIPT
-CLAIMS
FROM THE ISSUANCE OF THIS FERMI ISSUANCE OF THIS PERMIT BY ALL NOT BE
Te' HORMNANCE
PLAN CHECK DEPOSIT
!I
DEEMED TO MODIFY, WAIVE OR REDUC ANY REQUIREMENT OF AN' CIT
1. NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
TOTAL AMOUNT DUE
R CE ii
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
GIVEN I S CORRECT. AND THAT I AM THE OWNER. OR THE DULY AU rHORIZED AGENT OF
T�'. - . P.-Ift .01 -Ign.d by Ih.
THE OWNER. I AGREE TO C014PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
B,ildilo 011i.i.1 ., W D.P.ty: .1,:,pld. -d
TION;ANDIND ING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
0
RELATINGTO
v
FOR INSPECTIO N
tNVIOL ON 01 THE LABOR CODE OF THE STATE OF WASHINGTON
ATI
WORKMEN'S COMPENSATION INSURANCE AND RCW I B.27.
OFF I LSSiGNATURE DATE
45�
(425)
2014 -7 / �vA
771-M20
EASED BY DATE
'7 __jATE�NED
ATTENTION
EXT13321
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771 _0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
--------
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
w9a
z
0
fn
0 m
c a , :
m 0
0
c
m
10
ca
9
IC m
A
o
rn
z
cl)
z
0
j
0
m