20000897.pdfPERMIT EXPIRES 5 ------ (0
USE PERMIT
CITY OF EDMONDS 'ONE NUMBER '90 b8q?
CONSTRUCTION PERMIT APPLICATION A -B SUITEIAPT�
]DRESS
A
OW;� ME OF BUSINESS PI -AT NAMEISUBDIVISI.N NO, LOT NO LID NO,
AM, LID FEE B
MAILING ADDRESS TE11P A1111111
4 RYI P.,
PUBLIC RIGHTOFWAY PER OPFICIALSTREET MAP
EXI TING — PROFOSED�
ZIP ELE "ONE Ul
�:�.Mkfl'.ld
ld
&ITILI REQUIRED DEDICATI.N— FT
_6�
METER SIZE I LlIE51ZE NO. Or FIXTURES P V REOU19ED
NAME YES 0 No
111 =R�,5 111RIE FOR EROSION CONTROUDRAMAGE
t lmo / p a
ENGINEERING
)ATE
ADDREISS
12601
FIRE REVIE-E..Y
CATE
OTT TE PIT
braild.
INSPECTION BOND
VARIANCE OR CU
SHORELINE OR ADSO
REDO POSTED
STATE LICENSE NUMBER E 'I.A Ir. N
E3 Y rS 0�0
-Fh5Tuj OI�2- t)
HEIGHT
ki 6
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED ALLOWED PROPOSED
P101ElT�7jjlllNTPAl EL NO.
I
WO
NEW Ca,14SMENTtAL 9-11LUMBING I MECH
OVERAGE
kLi-OLWOTEDC PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS IFT)
FRONT SIDE REAR FRONT UPSIDE REAR
0 ADDITION COMMERCIAL o C MPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA PLANNING REVIU 11
REMODEL 0 APARTMENT 0 SIGN
REDD I PROVIDED
FENCE
E] REPAIR ci GRADING CYDS El ( _ X ITI
F-AH11
C] DEMOLISH C3 TANK C] OTHER
GARAGE RETAIININD WALL C3 RENEWAL
01 CARPORT PR
ro,
Is
ITYPE OF USE, BUStNE OR ACTIVITY) EXPLAIN:
CHECKE BY
TYPE F TON
f—RUC
OCUPANTA
NUMBER
UMBER OF
CRITICAL
SP CIAL INSPECTOR
RE OCCUPANT
OF
o STORIES 1
WELLING
U. 1
AREAS
NUMBER
REQUIRED [3 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
E401311t!SS INSPE��TIONS PER UBC 1081FINAL INSPECTION RECI'l
VALUATION I FEE
PLANCHECKFEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO: VESTED DATE
PLUMBING
.EC ICAL
NOTE06NTH S PERMIT COVERS WORK TO
THIS PERMIT AUTHORIZES ONLY THE WORK I'
AN, C
BE DONE ON PRIVATE PROPERTY ONLY. STRUCTION ON THE PUBLIC
REQUIRE
GRA.M."ILL
WALKS,DRIVE AYS, MARQUEES, ETC.) WILL
DOMAIN (CURBS, SIDE W
SEPARATE PERMISSION-
W�s PCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM. I YEA PROVIDED IN FIX S STARTED WITHIN 1811 DAYS
R o I
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ALI OF "IS OR HER SPOILS, rt.�LAISIGNE AND BUCCESCIPS
"E�. HARMLESS THE CITY F
;�AP' PLICAN.TT oN.BEE H
ENG. INSPECTION FEE
LANDSCAPING
IN
NT IE A R ES To gE.N"Y. AD AGENTS FROM ANY ANoo
TE.FlICIAlE. EMPLOYEES. No
INSPECTION FEE
EMoN%WASHlAGTol,
ALC"M '.R. MAGESOFWHATEVERNATURE.AR'S'NG DIRECTLY OR N.'N.TLY
HIS SHALL NOT BE
Iss F T I
RECEIPT
PLAN CHECK DEPOSIT
HE I =F'I. AIVEORREDUCEA YUA�GE. 'PERMIT
C E THIS PERMIT
W o QUIREMENT E
FROM T F 0 ANYCITYORDINANG
DEEMFBT. R
ORDINANCE PROVISION
YN
NOR LIMIT INANYWAYTHE CITY SABILIT TO ENFORCE ANY
TOTAL AMOUNT DUE
s-
I HAVE READ THIS APPTLIC�ATION� THAT THE INFORMATION
APPLICATION APPROVAL
HERERY ACKNOW R UL AUTHORIZED AGENT OF
IVEN IS CORRECLEDGE THAT
T AND THAT' AM THE oWNER6 STA UC
REGULA'Tl_�G CoNSTR
CALL
IiI �lol " by t.d,
011111 -1 D.p.ty, d F111 11. F.1
THEOWNER I AGREE TOCOMPLYWIT- CITYAN 'TEN.'AWS
TION. AND IN DOING T HE WORK AUTHORIZED THERE PERSON 'L PL'YEl
TO
FOR INSPECTION
13.06�1
,RIldqld p,d0d.
IN �IOLATION OF THE LABOR CODE OF THE STAT 'AS" NIT" RELATING
Ey"
DATE
WORKMEN S COMPENSATION INSURANCE AND RCW IS 21
(425)
OFFICIA SIGN��
7s ll�FNT �
10
DATE SIGNED
// 1, t"
I
I
'/11E
1?-
" "
N ttmrotsl
f I I _uzeu
EXT 333
RELEASED By
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
—INSPECTOR
—YELLOW
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
QRiGINAL-FILE - -
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
S19B
z
0
5 ' :
m
0 fin'
c
rn 00
80
c
c
m fn
z
10-1
c _z
om
n
x m m
C3
0
c: cl)
c co
M 0
Z r-
z
z
9
0
m
=i T, I �
m 0
c
0 -n
n
m m
0
0
0
C=
S,
M 0
Z
7-1
z
z
0
m
DATE RECEIVED
L 0
PERMIT EXPIRES �_ L
us'
PERMIT
CITY OF EDMONDS ZON
NUMBER
ADDRESS T� r7, _�o
JOB
CONSTRUCTION PERMIT APPLICATION
OT;�TME 01 BUSINESS
PLAT NAMEISUBDIVISION NO.
LOT No,
LID No
LID NO,
/NEM
I
LID FEE $
'I. FEE $
MAILING ADDRESS
Alig a)
PUBLIC RIGHT OF WAY PER .110�1. STREET MAP
EXISTING — PROPOSED-
IFE.CE.ICATI.N— IT
cp A,-.. 0
P ".a
=-A A —
e R.aa
tt 00
a I a I p.le
.. a..,k �4.%.'.' 0
ald—le D
.a "d
.P R.-
77/.X-11,olfido --/mg 71- _q"
NAME
I cl SIZE LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
FRV REQUIRED
YES . No
YES 13 NO 0
V ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
NA)��ENGINEERING
REVIEWEDIDATE
12 A7
152hc1,,qt1g ItIg-
o I lip IV JTE�Ps
C b f /,g 2r.
FIRE REVIEWED By DATE
VARIANCE OR cu SHORELINE OR ADBN
INSPECTION
REGO
C3VES C3 No
I BOND
POSTED
STATE LICENSE NUMBER
osz 0 ):_ K2.01-
SEPA REVIEW
COMPLETE EXEMPT ALLOWED I IROPOSIO
HEIGHT
ALLOWED , PROPOSED
IA. U.
PROPERT�72CCOUNI 11
nio-bL-
EX P I
NEW [!J"PLUMBING I MECH
CU�,IfESIOENTIAL
LOT COVERAGE REQUIRED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR
PROPOSED SETBACKS (R.)
FRONT URSIDE REAR
COMPLIANCE OR
0 ADDITION COMMERCIAL CHANGE OF USE
ED BY DATE
0 REMODEL C] APARTMENT SIGN
RVQ*D I PROVIDED
F NCE
[3 REPAIR GRADING CYDS 0 E_ x FT)
REMARKS
(3 DEMOLISH TANK OTHER
q
o
GARAGE RETAININEWALL RENEWAL
LCIJ CARPORT OCKER
(TYPE OF USE. BUSINE OR ACTIVITY) EXPLAIN:
C
CCLFANT
GROUP
�NUMBER
OF RIES
o STO
r MEER OF
C WELLING
U.—
CRITICAL
AREAS
NUMBER
OCCUPANT
S ECIALINSPECTOR REA LOAD
RPEOUIRED C] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
I
hy oto
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING I LOT SLOPE I BUILDING
1 4—
PLAN CHECK NO: PLUMBING lyb
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, T" 5 PERMIT COVERS WORK TO
BE G.NE ON PRIVATE PROPERTY ONLY. ANY CONSTLICTION ON THE PUBLIC 3FAADINGIFILL
..A,. 'CURES, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
01�=RCRARGE
PERMIT APPLICATION: 160DAYS
PERMIT LIMIT.- I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW F ES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
214G. 19SPLbTION FEE
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, A�s7G�i�=A�D SO' ESORS
IN INTIREIVT�,AAGRE.ETI.To INDE'T"" DEFEND AN. HOLD AF.LESs THE CITY - LANDSCAPING
EDMONDS. SHIN N, ITS.111CIALS, EMPLOYEES, AND AGENTS FROM ANYAND INSPECTION FEE
OFWHATEVER NATURE� ARISING DIRECTLYOR INDIRECTLY RECEIPT
A LCLA"SFOoRDA"G'l'THISPEA.I1 ISSUANCE OF THIS PERMIT SHALL NOT BE
m FLG.THE, LA E. PLAN CHECK DEPOSIT
, D EMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE -
o W 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. IPT
OR LI MIT IN ANY WAY THE CITY TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN RRECT. OR T E DULY AUTHORIZE. AGENT OF T�w .1ple.11- 1� - - "' ual,l ..U,.d �l
'SN ER' AND THAT I AM THE OWNEI STAIR CALL Bl�ldllg Officlal 11 hIllhIl DePuty:
THE DW . I AGREE To C .. LyWTHCIly. E LAWS REGULATING CONSTRUG Ild Fall all d. Ild
TION: AND IN GONG E WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED FOR acl,pt,l lckll.11dgld.a pace p,ov,dod.
IN VIOLATION OF T TH LABOR DE OF THE STATE OF WASHINGTON RELATING TO INSPECTION
HE Co DATE
WORKMEN S COMPENSATION INSURANCE AND RCW 18,27. - OFFICIA STGN,,T F`-,�
(0 RO ENT (,L-4
17 DATE SIGNED (425) it (, j�)
1 (11 -ue4u RCLEASEDBY u—
,/UR9
A*aNTrON EXT333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTU�E UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
5/98
z
0
0
rn
_z
0
n
rn m
0 Ir
0 M
2 CD
M 0
z
--I I
X
55 ; I
z
9
0
rn