20000931.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/N ME IF BUSINE S
AAV �..' W""! 1,-"5
MAILINGADDRESS
C
CITY 'UNE
ff IT' -5 7 75 5 3.
NAME
ADDRESS
G�Ty
N N ME
AME
ADDRESS
0
C C,
ITY
T�
STATE LICENSE
ZIP ITELEPHONE
1
PERMIT EXPIRES
90
—
-BE PERMIT 2C091m.
Z.1,tE 4S&, NUMBER
JOB SUITE/APT#
ADORESS'g��03q' t4+1 1'7
� �J/) 4-1VOil
-
PILfiT NAMEISUBDIVISION NO:
U NO.
_LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED -
REQUIRED DEDICATION —
METER SIZE
LINE SIZE
NO, OF FIXTURES
'ITV EQUIRIO
I
I
YES 0 NO 0
REMARKS
111—MIRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED By
DATE
ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADS.
INSF
EXPIRATION
'd
---
4DO A9&I
SERA REVIEW
SIGN AREA
HEIGHT
0
COMPLETE EXEMPT
I
ALLOWED PROPOSED
ALLOWED PROPOSED
eV71 vz
IlXP
12-
1 67. &
0 NEW
0 PLUMBINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS fFP)
FRONT SIDE REAR
PROPOSED SETBACK$ (FT.)
F US SIDE REAR
PONT
0 ADDITION
o C MPLIANCEOR
CHANGE OF USE
PARKING
LOTARSA
DA E
0 REMODEL
R SIGN
PROD I PROVIDED
/
0 REPAIR
C] RADING CYDS
0 FENCE
X
FT) REUPH"
C] DEMOLISH
0 TANK
C3
o GARAGE
ARI.._O
RETAIINING WALL
ROD ERY
C] RENEWAL
CHECKED 8 TR UIC C 0 u NT
GROUP
NUMBER
NUMIT'S' F
DWELLING
ARMCA
C L
SEAS
8 ECIAL I OCCUPANT
LOAD
OF
STORIES
N
D
REQUIRSIM
DESCRIBE WORK TO BE DONE
REMARKS
OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTI
A
VALUATION FEE
PLAN CHECK FEE
HEATSOURCE GLAZING I LOT SLOPE % B LOING
PLAN CHE 1 0: P UMBING
ECHANICAL
THIS PERMIT AUTHOSIZ ONLY THE WORK NOTED� THIS PERMIT COVERS WORK TO
RIV;Z
'ONE ON PRi PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGtFILL
D
5 WAY
5 DOMAIN (CURBS. SIDEWALKS, DRIVE S, MARQUEES. ETC.) WILL REQUIRE
I SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATI N: ISO DAYS
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG, REVIEW FEES
;A PLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
I EMNtFY. DEFEND AND HOLD HARMLESS THE CITY OF
N INTEREST. AGREES TO :N
EDMONDS, WASHINGTON, TSOFFICIALS.EMPLOYEEELANDA ENTS FROM ANY AND
��.LtjnS,�GRDAMAGESOFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
9 nF THIS PERMIT. ISSUANCE OF THIS P ERMIT SHALL NIT 81
F ANY C'T'.R.'NA�G'
ROMANCE PFOVISION�
ENG, INSPECTION PEE
N P E
PLAN Cl ECK DEPOSIT
TOTAL AMOUNT DUE
o 0
R CEIPT
-
0
RICEG id? 2
'H REGY ACK LEGG' THAT � HAVE SEA THIS APILICATJON� THAT THE INFORMATION
Gl= S C.S'.'ECT AN. THAT AM THE ODINER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER U�ITII Cl Y AND STATE LAWS FE.LLAHN. C.NSTRUG
I AGR,,TOCOMILY
T1.1 AND IN GOING THE WORK A HOSIZED THEREBY, NO PERSON WILL BE EMPLOYED
DILATION THE STATE OF WASHINGTON RELATING TO
IN VI COF THE LABOR CU;NOFE AND RCW 18,27,
WORKMEN'S OMPENS
APPLICATION APPROVAL
CALL B'il Tb,, pplj I, uAld l,bld by tho
d'ba Offi-i b, h', O.wv; .,,P F P.,d�
FOR INSPECTION kwIbdl.,I IP p—ld-
OFrICI E DATE
(425)
771-0220
ELEASED By
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
EXT1333
771-0221
FAX
At
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
5S8
z
0 M
c
m 0
o
m
0 -n
rn m
0
m
m
ol
z
z
m
FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE—
ERING DIVISION DATE—
z
0
WNING DIVISIONDATE
PROJECT----1526--� Z2L11qd)TAi5
ni
M 0
0
80
SrIE ADDRES
C
PERMIT #,ALZg �_ADB#V ')_-�DATE INSPECTED—
M
M z
10 -1
DESCRIPTION OF WORK TO BE INSPECTED—!��-J-A)-
C Z
A field inspection was conducted to determine compliance NNqth approved plans. Final approval denotes that
o -n
-n
there are no objections from the above signed Department to the granting of
M M
Final approval of the described work M4y 2 8
0
2 M.
-GRANT FINAL PROJECT APPROVAL
9 CD
M 0
PROJECT APPROVAL WITH CONDITIONS NOTED
z
__jGRANT
Cl)
z
FINAL INSPEC TION - OUTSTANDING ISSUES
0
i
0
M
2.
3.
___RE-INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp:bldg:forMS6/98
, m
7- �7, _.i
DATE RECEIVED
q lot,) PERMIT EXPIRES --2Za-Q—
.. PERMIT
CITY OF EDMONDS Z-B NUMBER
CONSTRUCTION PERMIT APPLICATION jos SUITE/APT�
ADDRE.SA_ -7
3 �40
OWNERNAMEN MEOFBU 'jU Lq q
NOS
PI NAMEISUBDIVISION NO.
LOT NO!
NO,
LL�O
Alt..
I
FEE S
MAILING ADDRESS
Av�e 5vAs 117
PUBLIC, FIGHT 01 WAY PER OFFICIAL STREET MAP
0
A 11"u".b
00
-CITY
(_jyOV'(A
ZIP
EXISTING — PROPOSED—
00
ITELIPHONE
F_ 3 ^,A A,,
495 7_155-3:1
REQUIRED DEDICATION— FT —
—ci
I
"NAME
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
I
YES El NO 13
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
TELEPHONE
NAMh'n�cll
1) 01
ENGINEERING Vth1tw3ATE
ADDRESS
FIRE REVIEWED By
DATE
0
CITY ZIP
TELEPHONE
z
10
_jTATE —LICENSE
VARIANCE OR CU SHORELINE OR ADB�
INSPECTION BOND
NUMBER EIPIRATIONOA�j
GIICKIDIY
;?'qaj�4
ED
)<
POSTED
SEPA REVIEW
_q
SIGN AREA
T
PROPERTY TAX ACCOUNT PAR
COMPLETE EXEMPT
PROPOSED
ALLOWED PROPOSED
&/
7
EXP I
12-3
q.
1q"1_
LOT COVERAGE
REQUIRED SETBACKS 6T
PROPOS SETBACKS (FT.)
rn
0 NEW
SIG NTIAL
PLUMBING I MECH
ALLOWED PROPOSED
FRONT SIDE RE AS
FRONT L/RSIDE SEAR
m a
0 ADDITION
COMMERCIAL
T�AEPARTEMENT
COMPLIA CEO
CHANCE -
-
,
8 0,
PARKING
LOT AR
C3 REMODEI
SIGN
D PRO I E
3: M
F NCE
GRACING GYDS
REPAIR 0 ('_ X FT)
EMARKS
JO
C] DEMOLISH 0 TANK o OTHER
16
>
GARAO'
GARA E
RETAINING WALL
CARPOORT R.GK'. 0 RENEWAL
CARPORT
A.
T PE 0 US BUSINESS OR ACTIV
YPE 0
C4 If
HE KED BY
TYPE
_n
1
NUMBER
NUMBER 0 F
CRITICAL
SPECI AL 'NSPE
CTOR
R,
10
WELLING
AREAS.
NUMBE
JAREA
FE.. IRED YES
005,
SO I WO To
DESCRIBE WORK TO BE DONE
RE ARKS
OGRESS INSPECTIONS PER UBC
ON R
a
0
c
P
M C)
x V _j
12 4&a6&_&o
z
,A JUIA 1.4
z
VALUATION
FEE
PLAN CHECK FEE
z
HEATSOURCE GLAZING %
LOT SLOPE %
BUILDING
PLAN CH
VESTED DATE
PLUMBING
MECHANICAL
I THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COVERS WORK TO
=1 BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
91 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GRAOING/FILL
SEPARATE
STATE SURCHARGE
PE EMIT APPLICATION: 160 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED W ITHIN 180 DAYS
ENG. REVIEW FEES
SIZE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG, INSPECTION FEE
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
THE CITY OF
INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS
N ANYAND
WASHINGTON ITS OFFICIALS EMPLOYEES AND AGENTS FROM
INS FEE
2
EDMO
ALLCILAIMSFORDAMAGESOFWHATEVER NATURE,ARISING DIRECTLYOR INDIRECTLY
SHALL NOT BE
x
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
7-V
7' — -
9
0
DEEMED
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE F-1--
C7 Q,
TOTAL AMOUNT DUE
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I A. THE OWNER. OR THE DULY AU111111111111 AGENT 01
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Thil PPj , p,,.it until,,gPed by thO
eum'q OffiP., .' hw D.Pu'T ..,, F ... .. p. d. -d
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
--- INSPECTION
FOR
vdb
Tempt is acknowlodgod m spac* PIC d.
IN VIOLATION OF
WORKMEN'S COMPENSAIIO��
6FFIC A IONA E DATE
_5,I1NCEANORCW18.27,
SIGNATURE (OW N
(425)
771-0220
ELEASEDBY DATE
ATTENTION
EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED� USC SECTION 109
FAX
1 ORIG - NJ ' YELLOW 'NPEOTO'
INAL. BOR
PINK - OV044ER GOLD - AEB.
Sma