20000888.pdffAWIN DATE RECEIVED
I I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENA"; 7"",.,
MAILING ADDRESS
XA/
CITY
0 Zt, -776
NAME
ovirl
USE
ZONE
PERMIT EXPIRES ��J
PERMIT
UMBER (96,09VIE
SUITE/APT#
PLAT jTAMEISUBDIVISION NO�
I LOT NO,
LID NO�
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIREDDEDICATION� FT
METER SIZE
OF FIXTURES
PRY REOUIRI
yes 0 No
FIRE REVIEWED By
DATE
CITY
ZIP
VARIANCE OR CU
SHORELINE OR ADB�
NSREOTtON
SO
IPOSNTEDD
STATE LICENSE NUMBER EXPIRATION
DATE
CHECKED BY
j
D
C3YES ONO
SERA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
I
I
I
70ZOOOOCO-5_0006
EXP
- - -_
LOT COVERAGE
REQUIRED SETBACKS (FT)
FRONT S IDE REAJI
PROPOSED SETBACKS (FT)
FRONT UPSIDE REAR
Ew
XRISIDINTIAL
(c] LUMBING / MECH
ALLOWED PROPOSED
6'AODbTIONI
C] COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA
C3 REMODEL
0 APARTMENT
0 SIGN
RED I ED
D
4"�
0 REPAIR
0 GRADING CYDS
0 IT)
RI-AHl-
PC) L) _00C)
0 DEMOLISH
0 TANK
XOTAb
0 GARAGE
CARPORT
r-1 RETAINING WALL
— ROCKE I
0 RENEWAL
C POTION GOOD
_:!Ill�CKE N,' HPIN
D By TYP'OCo k2 ISIFIO'
"AL OCACU
NUMBER UMBER PE.'AL INS '�.Rl.EA
OF D.ELLI.GF PEAS R U'RE. aCyES Lo ) PA
U A
STORIES / NUMBE ................. .
DESCRIBE WORK TO BE DONE
REMARKS"
Pr
i =R UBC 108/FINAL INSPECTION
VALUATION
FEE
GLAZING % LOT SLOPE %
BUILDING
PLAN CHECT ST E D D.AT E
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURES. SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQU18E
SEPARATE PERMISSION.
GRADINGIFILL
RCHARGE
P FIMIT APPLICATION! HID DAYS
E ITHIN 180 DAYS
PERMIT LIMIT, I YEAR � PROVIDED ORKISSTARTEDW
SEE BACK OF PINK PERMIT FOR MORE INFDAMATION
END. VIEW FEES
'A PUCANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESoRS
p
IN tNT EST, AGREES TO
ED 'R S :NUEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
MON WASHtN TO TS OFFICIAL& EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLAIMSFoRDAG "� oFWHATEVER NATURE, ARISING .11 - -11 I -
FROM THE ISSUAN IS PERMIT SHALL NOT BE
CEAGO'F THIS PERMIT, ISSUANCE 05 TH
D EMED TO MODIFYWAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAYTHE Cil Y�SABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
EIG- INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
OTAL AMOUNT DUE
RECEIPT/64/da
PECS""
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
OWNER. OR THE DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT. AND THAT I AM THE TY AND STATE LAWS REGULATIN
THE OWNER. I ACRE TO CoMPI.Y WITH CI G CONSTRUC.
E D
TION: ANDIM DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE
IN VIOLATION OF THE LA80R CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND ROW 18,27.
I, E"..
APPLICATION APPROVAL
B."T P p,,,, .bI llgnld by th,
CALL F
llkP,19�d M , p—ld.d.
FOR INSPECTION
o CIALS SIG C DATE
(425)
A—
I If I -ve4v
RELEASED By
ATTENTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
BEEN MADE AND APPROVAL OR A CERTIFI-
EXT1333
771-0221
41,
ORIGINAL . FILE YELLOW - INSPECTo
A FINAL INSPECTION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD - ASSESSOR
z
o
49
vi -4
m
M 0 1 i .
0
0
c:
M
M z
-4
0 -n
'n
mT
a CA
0
0 Fn
to
(D
M 0
z
z
Z
m
ATE RECEIVED PERMIT EXPIRES
U21EF
61TY OF EDMONDS
PERMIT
NUMBER
SLATUAPT.
'WIL=
CONSTRUCTION PERMIT APPLICATION JOB
ADDS
OWNER NAMEINAME OF BUSINESS
vk ci
-
PI -AT NAMEISUBOIVISION N
T-
'10 FEE S
MAILING ADDRESS
Yy 4,1
slots if v )l vv
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED�
REQUIRED DEDICATION FT
P_ =11.
�lz 00
V . ......
CITY ZIP
L7 7-1.
TEL PHONE
775--/4o/
METER SIZE
NO* OF lIXTUR11
NAME
N
ADDRESS
REMARKS
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
A 1A P"
CITY ZIP
TELEPHO14E
�AME
- 7A
0 w �l
ENGINEERING REVtEWED/DATE
ADDRESS
FIRE REVIEWED By DATE
CITY ZIP TELEPHONE
Z
j VARIANCE OR CU SHORELINE OR ADB� 1W
EXPIRATION DATE CHECKED By
HEIGHT
SIGN AREA
PROPERTY TAX ACCOUNT PARCEL NO.
702-0tooCCO-S-0006
SEPA REVIEW
COMPLETE EXEMPT
EXP I
ALLOWED PROPOSED
I
ALLOWED PROPOSED
I
=i:fi
m
m
0
0
C:
4 m
X tn
rn
0
rn 9
0
o rm
I= co
0
z
>(RESIDENTIAL LUMBING t MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL rl APARTMENT SIGN
FENCE
REPAIR GRADING CYDS X FT)
0 DEMOLISH TANK
n GARAGE E] RETAINING WALL
CARPORT ROCKE IT RENEWAL
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACK$ (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS BFT)
FRONT URSIDE REAR
z
RED PARKING
_�D
I PRO�IRED
LOTAREA
PLA GAE 1 EW S,�
11-1441.
SSIOA115
F I
A�D U
(TYPE OF USE. BUSI S OR ACTIVITY) EXKAIN:
rL—,:5/.6E
OCCUP NT
TCODE� A
GROU
I
NUMBER
OF
STORIES
NUMB6RO
DWELLING
UNITS
CR TICAL
AREAS
NUMBER
SPECIAL INSPECTOR
REQUIRED E] YES
JAREA OG-U 'ANT
L
flE
DESCRIBE WORK TO BE DONE
,e: 1:5 7t,,141(f
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL RE.'.
>
L
VALUATION
PLAN CHECK FEE
z
H SOL% GLAZING I LOT SLOPE I
BUILDING
VESTED DATE
PLAN CHECK NO'
PLUMBING
0
m
ILL :L
MECHANICAL
THIS PERMIT AUTHORIITE�S ONLY THE WORK NOTED, THIS PERMIT COVERS WORK 11
BE .NE ON PBV. PROPERTY ONLt ANY CONSTRUCTIO N ON,THE PUBLIC
MARQUEES, ETC,, W LL REQUIRE
FA ]NOIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS,
SEPARATE PERMISSIOM
CHARGE
PE MIT APPLICATION: 180 DAYS
RR
I YEA , PROVIDED WORK IS STARTED WITHIN ISD DAYS
ENG, VIEWFEES
PERMIT LIMIT.
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF 0 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
OF
ENG. INSPECTION FEE
;APPLICANT.
N INTEREST, AGREES TO :ND NtFY DEFEND AND HOLD EBB THE CITY
TS EOMFFICIALS. EMPLOYEES� AND AGENTS FROM ANY AND
NDSCAPING
INSPECTION FEE
SHI GTON.
EDMONDS.WA OFWH �'Nn IRECTLY
IF ATEVER NATURE, ARISING ORINDIRECTLY
A SHALL NOT BE
gpMSFO
THIS PERMIT
DEPOSIT
RECEIPT/ WO
P SMIT, ISSUANG E OF
THIS E
OF ANY CITY ORDINANCE
PLAN CHECK
ORDINANCE PROVISION.*
RECE
T OUNT DUE
I HEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN R,RECT, AND THAT I AM TH , OWN
SRATT.H, DUILVIAUTHGT�g�.�D AGENT OF
I y Co CONSTRUC-
T h
6
ANR
THE OWNER. AGREE To COMPLY WITH CITY �T LAWS " U,
WILL BE EMPLOYED
CALL
B,ild,,, OjjKj.I .1 him1h., D -d F
C THEREBY. NO PERSON
TION� AND IN DING THE WORK AUTHORIZED E STATE OF WASHINGTON RELATING TO
TH
V.p.y:
FOR INSPECTION _,ipt i� ,mov,jo g,d i, splo prmided.
IN VIOLATION OF THE LABOR CODE 0
WORKMEN$ C��ATJON INSURANCE AND ACW 18.27.
0 F CIALS SIGN
SIGN, WNER R AGENJ) DATE SIGNED
(1425)
-
771,-0220
RELEASED By DA E
ATTENTION
EXTJ333
L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
-
- 771-0221
A FINAL INS ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
P
ORIGINAL - FILE YELLOW - INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109
FAX
PINK OWNER GOLD -