20000756.pdfDATE RECEIVED
I_A42-0�
I
PERMIT EXPIRES 311�7
[
CITY OF EDMONDS
USE
'-N' L5-,,�c.',
P T
EuRim.E. .2,00756,
CONSTRUCTION PERMIT APPLICATION
J..
ADDRESS
SUIJ�APTI
Av LZ,
OWNER NAMEMAME OF BUSINESS
P�T NAMEISUBDJVISION NO.
NO�
LOT NO L —
r-,I, I r, J�
y -1 rt'x fn _V
DFEES
L�D
MAILING ADOPSks
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TEIl.PAl
CITY ZIP TELEPHONE
EXISTING— PROPOSED —dal� I,.qull.�
6'f6b:)�,
ASOUIRED111DICAT"N
FT
METER SIZE LINE 511E
N1,01111TI)RES PRV REQUIRED
NAME
I
I YES 0 NO 0
I
ADDRESS
REMARKS
RESPONSIBLE FOR EROSION CONTRO�DRAINAGS
ZIP
I -A _J
FIRE REVIEWED By DATE
'RE IIWED By
'REMAH-
C Ty P
I
r
T
TELEPHlE,,,,, )
R'
I , ,
SHORELINE OR �DB. INSPEC N
N CE PC OR AD5#
VARIANCE OR OU
VA A 'U SHORELINE
STATE LICENSE NUMBER
XlI�Allt OAT E CKEDBY
OTI
oy RE 0
ES ONO
I PBOND
OSTED
LAJ.A-�,U�_ �__) Lfh
SEPA REVIE
SIGN AREA
SIGN AREA
HEIGHT
PROPOSED
ALLOWED PROPOSED
ALLOWED
ALLOWED PROPOSED
PROPERTY TAX ACCOUI PlAl EL NO.
I
I
EXP
VO
R
LOT COVE AGE
REQUIRED E�TEAOK- I_,
REQUIRED SETBACKS I"T I
PROPOSED SETBACKS (FT)
EW
IAL
P�J-E.I.E�,ITIAIL
FLU." '.ECH
PLUMBING' -ECH
ALLOWED PROPOSED
FEAR
FRONT SIDE REAR
FRONT S,
FRONT UPSIDE REAR
COMPLIANCE DR
ADDITION
.A
I AL
, E US
_HANG OF E
CHANGE OF USE
PARKING
LOTAREA
PLANNING FEVI.
DATE
C3 REMODEL
I
tzL&AM
'T
[3 APARTMENT
SIGN
C3 I. N
R G�D
E
I PROVIDE
.1
11I.ANNINIIEVIEWEDIN
FENCE
FENCE
E] REPAIR GRADING CYDS X FT)
E.
R ARK
B
0 DEMOLISH C] TANK
OTHER
RA E
Cl GAFPGRT RETAI.N�-WALL 0 RENEWAL
I,,,
c USE, U OR ACTIVITY1 EXPLAIN:
OCCUPANT
`17
(VPE
'qNESS
CHECKED By
W�EMA.K�
ITYIE 01 TI.N
TYPE O'C N
GROUP
NUMBER
NUMBER
ITICAL
CAREAS
SPECIAL INSPECTOR
AREA
U
-CA
OF
OF
OWELLINO
YES
JAHEA
L.
STORIES
I__
UMBER
Kr%A4*m lot 0
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RED
VALUATION I FEE
Irl ILA
_,A" CHECK FEE
LOT SLOPE I
BUILDING
cv
VESTED DATE
PLAN CHECK NO�___
PLUMBING
ECHINICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADtN 011ILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION,
ARGE
PERM T APPLICATION: ISODAYS
' 11
PERMIT :LIMAIT: 1 YEAR * 'PROVIDED WORK IS STARTED WITHIN 160 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUC ESORS
ALF OF
END, INSPECTION FEE
I I N INTEREST. AGREES TO INDEMNIFY. OFFEND AND HOLD HARML ESS THE 1111 .1
LANDSCAPING
DMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
E ED INDIRECTLY
INSPECTION FEE
A L CLAIMS FOR AMAGEI - WHATEVER �ATUF�. ARISING DIRECTLY OR
AL or
F LL IS
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
RECEIPT
PLAN CHECK DEPOSIT
A, , REQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY
T 0 ENFORCE ANY ORDINANCE PROVISIOW
CEI
RECEI
.F:::
TH�5C
I NOR LIMIT IN ANY WAY THE CITY'S ABILITY
U E
READ THIS APPLICATION; THAT THE INFORMATiON
APPLICATION
APPROVAL
I HERESY ACKNOWLEDGE THAT I HAVE
GIVEN CORRECT. ANDTHAT I A.THE OW.�.6�0T�ATTHE .�LYRAUTHOTt'110 AGENT OF
IS
In -PPI".n P—a an", n9n.d �' ".
THEOWNER. IAGREETOC LYWTHOTYAN LAW EGLI, NG CONSTRUC-
OMP
CALL
aro -2 a',
'u, dl g 0[kial .1 h,llhll D,P,ty: and Fe.. P
TION.ANDIN DING HE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
,
a—p- acknowlodgod in space pro '. ad
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN S COMPENSATION INSURANCE AND HOW 18.27.
0 IALS. ONATURE - DATE
SIATURE (OW"(` '
Ill[INE1
(425)
')
i -,
771-0220
RELEASE .1
'TION
EXT 333
A17EN
IT IS UNLAWFULTO USE 08 OCCUPY ABUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW - INSPECTOR
- ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD
519B
z
0
rn
=i 96
55
C= m
M 0
0
c:
Fri
z
c
r-
o -n
m rn
0
o
C ch
c co)
M
z
X
z
z
0
m
RECORD OF INSPECTIONS
CITY OF EDMONDS
Z84 P:5- J,-)C:t�2
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
'A'DoD R E S s
Ua
Cl
A' -
J L
OWNER NAMENAME OF BUSINESS
FLAT NAMEISUBDIVISION NO
LOT NO
I N
non.Ta fn p r, a
LID
DFEE$
ADDRE S
MAILING ADDRE
PUBLIC FIGHT OF WAY PER OFrICIAL S7 FEET MAP
ESp AP-1—
A
Exi TING � PROPOSED
o
CITY
TELE HONE
REQUIRED DEDICATION—
IT
METER SIZE
LINE SIZE
NO, OF FIXTURE$
P"V REQUIR D
NAME
YES C3 NO 0
ADDRESS
R MARKS
nVINF—ONTRACTOR
RESPONSIBLE FOR EROSION CONTROUDRAMAGE
CITY ZIP
NAME
:foa c E FIRE REVIEWED By DATE
S...ELI.E H AD84 INSPEC� JPSONEO
XPIHAII 1. 11— 'ED BY 1AIIA111 OR 011 REO DON
DST
E LICENSE NUMBER YES 0 NO
Co, SEPA REVIEW SIGN AREA HEIG14T
FEEL NO. ILITE I EXEMPT ALLOWED P OPOSED ALLOWED PROPOSED
M! EXP I -
0
10 m
r_
rn
REQUIRED SETBACKS( PROPOSED SETBACKS (FT.)
LOT C VERAGE PTI
>Z3 EW ESIDENTIAL PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
0
C3 ADDITION OM.ERCIAL o COMPLIANCE
HANDS OF USE EDBY DATE
ro
0
PARTMENT
E] REMODEL A SIGN
c
FENCE
rn
m
REPAIR GRADING CYDS X FT) ReMAF-
DEMOLISH [3 TANK OTHER
>
0 ARA RETAINING WALL RENEWAL
cn
lG:AFPGRT .GK.,
0 INESS OR ACTIVITY) EXPLAIN Cq OCCUPANT
0 -n
(TYPE USr, E EDSy ITYPE.E�(j;OCTION I
GROUP
NUMBER NUMBER OF C ITICAL SPECIAL INSPEIT11 OCCUPANT
A IA
rn
LOAD
AREAS Go I'
OF DWELLING R REQUIRE YES
L"nq NUMBS
m
I
o STORIES
DESCRIBE_!yE,,K jo�OI(E REMAR S
0
o
nj�Q no RIESS INSPECTIONS PER U.0 108/FINAL INSPECTION REQ'D
C co
A(c Luin'
M 0
z
7`1
(Ao Yll
'n
4"'9- v in
z
� N in-4 k2- VALUATION FEE
qa p
_Jc: If) PLAN CHE K FEE
bwtr
rn
z
�Ll CE GLAZ I LOT LOPE % BUILDING
9
6-".l eo
0
VESTED DATE PLUMBING
PLAN CHE > CK Nq_
m
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCT ION ON THE PUB LIC GRADINGIFILL
DOMAIN (CURB% SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
D SEPARAI E PERMISSION. ARGE
2
PERMIT APPLICAT19N: ISO DAYS
P K IS
PERMIT LIMIT, 1 YEAR. ROVIDEDWOR STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INF ORMATiON
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS ENG, INSPECTION FEE
IN ,N.TNEFEST�AG,,,.E.ETSGN,. �TG.E.NIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
ANYAND
ES H FC EMPLOYEES, AND AGENTS FROM INSPECTION FEE
ED W INDIRECTLY
EIALS.
ALLCLAIMI IORDAMAGE SOFW"AT VER NATURE. ARISING DIRECTLYOR RECEIPT
OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
FROM HE .UANCE OF THIS PERMIT. ISSUANCE
TO MODjFy�yWTAHVECoRV�SE%LjCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED
W 6 IT LITYTOENFORCE ANYORDINANCEPRO-1— RE El T6 -1�
ORLIMITINANY TOTAL AMOUNT DUE 14
IHEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
T I, pp,ca,.e ie pt, u,fil eglld by
GIVEN WNEE, .11 TEE DUlyRAUTH0,R'll.ED AGENT OF
IS CORRECT. AND THATA. THE: N h
TRU C.
CITY AND STAT LAWS ULA , C CALL Bu,l
EMPLOYED dilg OII,Fel , hilft," DIPUtY: end Fee. .10 p d. ,d
THE OWNER. I AGREE TO COMPLY WITH .
AUTHORIZED THEREB N RE ON VAL BE
TION: AND IN 001 NO THE WORK Y' 0 FSNGTONL RELATING TO FOR INSPECTION ,P1 il 11—lodgad in space plevidle.
WASH'
IN VIOLATION OF THE LABOR CODE OF THE STATE 0 F
WORKMEN'S COMPENSATION INSURANCE AND HOW 18.27.
(425)
?S11 �NAT:URB(DW =F4,;O E.
[I-- , ) J2,( I .1044v
— EXT 333
ATTENTION
UNLAWFULTOII-q, OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
ITIS ORIGINAL -FILE YELLOW - INSPECTOR
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ASSESSOR
A FINAL
BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD -
CATE OF OCCUPANCY HAS
5m.