20000823.pdf`1 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
ZIP I TELEPHONE
ADDRESS
17T I— ZIP
NAME
IUD
PERMITEXPIRES �Z/I�LW
USE PERMIT
ZONE NUMBER
LRIT��IAPT�
77
ADDRESS
PILAT NAMEISUBDIVISION NO.
ro-
11 NO -
LID FEE
PU�L'��l.�TI)IIIAIPE�.IFIC;IAL�TRI�T�AP
0
10,
EXIST NO — PROPOS60 -
0
0
REQUIRED DEDICATION— FT �
U.,
0
METER SIZE
LINE SIZE No. OF FIXTURES
PAN REOUIRED
I
IES 11 NO 0
ARKS
F FOR EROSION CONTROUDRAINAGE
15
REMARKS
INC
ENGINEERING REVZEWED/DATE
ADDRESS
FIRE REVIEWED By DATE
CITY ZIP
ELE HONE
0
I,) -S
-1-1(2 67
VARIANCE OR cu
SHORELINE OR ADBN
SHORELINE OR ADDN
T
E N
INSPECTION
INS' CT'O
...
BOND
STATE LICENSE NUMBER EXPIRATION DATE
CHECKEDBY
REQ'D
RED D
DYES ONO
E 0
IPOSTED
SIGN AREA
IS
HEIGHT
CC (N %�2 C—: )k
COMPLETE EXEMPT
ALLOWED I PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCO UNT PAnCELNO.
I -A 73LI c,o
EXP
LOT COVERAGE
REOUIRED SETBACKS (Fl)
PROPOSED SETBACKS (R.)
NEW Ey<.IDEt,ITIA1_ [y PLU..IN.1.EC.
ALLOWED PROPOSED
FRONT SIDE REAR
R T B
'R NT U E F
FRONT UPSIDE REA
0 COMMERCIAL ci 0 MPLIANCE OR
AUDITION CHANGE OF USE
PARKING
T RE
LOT AREA
PLANNING REVIEWED BY DATE
P, I G EV E, Y
0 REMODEL APARTMENT 0 SIGN
REDID
I PROVIDED
0 FENCE
REPAIR El OR" CYD5 ( — X IT)
-HEM-11
DEMOLISH C3 TANK C] OTHER
RA' LL
G R b E
A A 'E C] R' WAL
0— CGA.1b.FT WA
C
(TYPE OF USE, BUSINESS OR ACTIVITYI EXPLA7W. _,5g2��E
�U IN
CIIECKE11Y
E 0 TRUCT;ON
-.-�.UPAVT
-SSO.-ACT'
A —1
ITY
I
NUMBER
.1
NUMBER OF
CRITICAL
PECIAL INSPECTOR
AREA OCCIPANI
OF
DWELLING
FL'
I
AREAS
REQUIRED YES
LOAD
0, STORIES
—
U N IT E
UMBER
C]
ESC.I.E WORK TO BE DONE
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION
-4—
is ;psi or ' closed, expans'on tanks are
I ranuired on ali nof via cr all s per
HEAT SOURCE GLAZING I
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION.
t:
2 PERMIT APPLICATI N: 100 DAYS
WITHIN 160 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED
SEE RACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT.
w N NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
,
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
X ALL CI_AIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
BE
Q
m FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THI PERMIT SHALL NOT
E
m DEEMEDTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITYOFIDINAN
ORDINANCE PROVISION."
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY
I HEREB—CKNO.LEDGE 'HAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
.1
GIVEN IS CORRECT: AND;.HAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT
C'NIPSLT.RYU�C.
THE OWNEFN AGRI , O"%YU�IT."�CITY AND STATE LAWS REGULATING
WIL HE F
01
TION; AND ORK �ED THEREBY, NO PERSON
I DING!/
STATE OF WASHINGTON RELATING T.
IN VI LAT, ABOR CODE or THE
WORKMEN ATION INSURANCE AND RCW 18 21
AT
F(7AGENT)
ATE SIGNED
A
/!2 - /.� -or)
VALUATION I FEE
PLAN CHECK FEE I
,5o.vo
MECHANICAL
GRADINGIFILL
V� C.ARGE
ENG. REVIEW FEES
ENG, INSPECTION FEE
LANDSCAPING
,P TK)N ,
INSPECTION FEE
E
RECEIPT
PLAN CHECK EP.BIT
RECEIPT
DUE
APP ICATION APPROVAL
CALL
81"1 Tb,, ppj,.,, T., b Ttij ,,,ld by 17-d
9 ojf� 111 h111 Dep,,Iy: a.d Foos "' "I
FOR INSPECTION
,,,,pt �� 11k.I1dgDd T, IP1.0 PI—d.b.
OFF) ALS SIGNATU
(425)
0
771-0220
ELEASEDBI
v MAI
E'
IT 71U.LVI'! G OR STRUCTURE UNTIL
ILTO USE OR OCCUPY A BUILDIN 771-0221 ORIGINAL FILE YELLOW -INSPECTOR
A A 'INAL �,P
FIN ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109 FAX
�198
z
rn
c m
IT,
0
80
c
m m
z
ri)
0
m M
0
om�
C co
9 , ,
m
z
z
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING........................ .
FRAMING ............ .........
FIRST FLOOR FRAMING
INSULATION
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..........
Z�
0
C) IT,
C C,
M
0
0
M
171 z
C
rA
0 -n
_n
M M
0 V5 ", :
0,
0 M
C Cn
z
z
0
0
IT!
-.7 7- W, j,
PERMIT EXPIRES
USE PERMIT
NUMBER
CITY OF EDMONDS ZU082�a, I
CONSTRUCTION PERMIT APPLICATION JOB SUiTE1APTN
ADDRESS
INESS
OWNER NAMEINAMEOP BUS
PI -AT NAMEISUBDIVISION 110. LOT NO. LID NO.
LID FEE
MAILI GAD R IE-411—
N ESS
:T MAP
PUBLIC RIGHT OF WAY PER OFFICIAL STREI P P.I.— 0
—.1 u.. P.— ".0 01
9-1 Lk) EXISTING PROPOSED— 0
CITY ZIP ITELEFRONE 0
FEOUIREDDEDICATION� FT
OF FIXTURES PRV REQUIRED
NAME yes 13 NO 13
REMARKS
OWNERICONTRACTOR RESPO ROSION CONTROUDRAINAnE
ADDRESS
CITY
EPHONE
NAME
JAI,= lie
ENGINEERING REVIEWEMDATE
ADDRESS
Z
FIRE REVIEWED By DATE
CITY
ONE
0
IRD;Lo
VARIANCE OR CU SHORELINE OR ADBN
INSPECTION BOND
REQ-D POSTED
OYES C3NO
STATE LICENSE NUMBER
CCpj=C- 'A MA 41/o/
0)(
SERA REVIEW AREA
COMPLETE EXEMPT ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
I
PROPERTY TAX ACCOUNT PARCEL NO.
n,4(-C)-7
EXP I — I
. a m
c
IT!
0
LOT COVERAGE REQUIRED SETBACKS (FT)
SIDE REAR
PROPOSED SETBACKS (PT)
FRONT UR SIDE REAR
V NEW RESIDENTIAL OKLU.13IN.IME.-
ALLOWED PROPOSED FRONT
0
0
E:i COMPLANCE R
0 ADDITION 0 COMMERCIAL C HANGE OF USE
c
NING REVIEWED By DATE
M
M z
0 REMODEL C3 APARTMENT 0 SIGN
REQQ I
PROVIDED
0 REPAIR GRADING YDS C] FENCE
X FT,
X FT))
c
>
EMARKS
OTHER
0 DEMOLISH C] TANK
AR BE 0 RMN
[3 G A. WALL
'ARiF FIT a
��EWAL
0 -n
-n 3D
rn rn
0
0
Y57
JYPE 01 USE. BUSlIE85 OR A1111IT LAIN
A-n.-
CHECK506Y
TYPE
I/yh
0 PANT
CODE CCU
GROUP
Cl 2
OF
CRITICAL
SPECIAL INSPECTOR
AREA OCCUPANT
OF
STORIES
NO
OUNITS
AR EAS
N MEER
U
M EQUIRED C] YES
LOAD
0
DESCRIBE WORK TO BE DONE
RENA KS
PROGRESS INSPECTIONS PE R UBC 1081FINAL INSPECTION REQ'DIZ
peprele. nf whelh-r Ih- x
MO
Z r
L'/ p
is opert or closed, �expansinn tanks aLe_
raquired on all hot VjRler tni%Vs per
z
eily Code.
ECDC MM-020TCT
VALUATI N
FEE
z
PLAN CHECK FEE
9
GLAZING % LOT SLOPE %
BUILDING
0
m
�g�IILRIE .
VESTED RATE
P LAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
"EVAO'NI(ONP.R.IVAT�P�.PERTY..LI.A�IC:(,..R.CTI.�-NI THE PUBL,'C
RADIN IFILL
gl CUP SIDEWALKS . DRIVEWAYS, MARQUEES. ETC.) W LL.E. E
SEPARATE PERMISSION.
)URCHARGE
PERMIT APPLICATION: 180 DAYS
T. PERMIT LIMIT', I YEAR. PROVIDED WORK IS STARTED WITHIN 180.AYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P LICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND BUD ESORS
A P
ENG. INSPECTION FEE
S THE CITY OF
�j IN INTEREST. AGREES TO INDE.NI Py. DEFEND AND HOLD HARMLES FROM ANY AND
LANDSCAPING
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR-—
INSPECTION FEE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0 DEEMED TO MODIFY. WAIVE OR REDUCEANY REQUIREMENTOF ANYCITY ORDINANCE
RE EIPT
NOR LIMIT IN A.YWAYTHE CITY'SABILITYTO ENFORCE ANYOROINANCE PROVISION.-
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT HEINFORIVA TION
APPLICATION APPROVAL
EN ECT AN HAT I AM THE OWNER. OR THE DU LY AUTHOR ZED AGENT OF
0
I d by hd
11111,1
OF T G. ULATMG CONSTRUC
�11RE "WUFORIA EE T PLY WITH CITY AND STATE LOWS kSEOGN
CALL B Y�t -d F...
PER L G
K THEIR W1
!T EWOR AUTHORIZED . EBY. N EMPLOYED
RELATING TO
'p— P,
FOR INSPECTION
r ' IA. OR CODE OF THE STATE OF WASHINGTON
IATI
ATION INSURANCE AND FCW IS.V.
. S T"
__SIGNATUR AD NT) ATE SIGNED
TV
(425)
A
I V&eu /RELEASED By
V
EXT 333
TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771 -042 1
UL
APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW. INSPECTOR
A FINALWSPECTION HAS BEEN MADE AND
UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED.