20000955.pdfDATE 'fl
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
�Fk27MI /,0 6
MAILING ADDRESS
— 8/L)T.
CITY zip ITELEPHONE
q, 2 -q
22
ADDRESS
CITY
NAME
AQ::L —C
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
'OBAPT'
ADDRESS
P�TNAMEJSUBDIVISIONNO_.
LOT NO-
LID NO -
LID FEE S
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP
' .p e,
El c
c
Ic
EXISTING — PROPOSED
ee -`-e C
c
REQUIRED DEDICATION— FT
.InItt
METER;;��
NO.OFFIXTURES
PRVR ... ME.
PRV
Y S . No .
ES 0 NO 0
YS
—p—H., FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED By DATE
:ITY ZIP
TELEPHONE
A* 31;v *o5
0 AD
SHORELINE OR ADS#
S OR '
OTI N
INSPEC
YR' -D
ES reo
BON"
P!sTE0
ED cu
VAHIAkE OR CU
V A 'A N
;TATE LICENSE I 'El
SERA REVIEW
IS
A RE A
SIGN AREA
G
S IN
HEIGHT
ROPERTY TAX ACCOUNT PARCEL NO.
CO PLETI I EXEMPT
W ED p 0 PC
ALLOWED PROPOSED
A '0
I
ALLOWED PROP.S�.
zs, I fvc
W44 QQQ Qq'
0 1 01
v'
. . ........
L
0 NEW
M E-H
PLUMBING I MECH
U .IN.
LOT C VERAGE
ALLOWED 0 PROPOSED
-U
REQUIRED SETBACKS -) PROPOS 0 ETBACKS
R E D A .K
FRONT SIDE HEAR FRONT EUS SIDE HEAR
N T S, DE R
-
- 101
cl ADDITION
p
COMPUANCEOR
M L' NCS
CHANGE OF USE
A NGE OF
2�5% IV(
7-5
PARKING
LOT AREA DATE
0 REMODEL
�N
SIGN
�IECJ.o SOVIDED
7
11 Aga 1A_np
1
F NGE
NOS
X FT)
0 REPAIR 0 GRADING CYDS X FT)
E A S
V_ Z
0 TANK
bit
DEMOLISH
Se4�611!fd
li�
ARA i;ETAKIFNING WALL HE. NEWAL
C OC FIL 0
Cl GA=0FIT
TIVITY) EXPILAIN:
CHICKIDBY
OUPA�
TYPEOICO�ST -"ON CO CR..
(7-1 0
NUMBER 'u"i"�TL.L
AREA S
$R 3
SPECIAL INSPECTOR
R OIOUPAOT
AREA
LOAD
OF
STORIES
,
NUMBER
REQUIRED C] YES
DESCRIBE WORK TO BE DONE
S S
REMARKS
UBC 1�
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE LO
BUILDING
PLAN CHECK NO:
P UMBING
013
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
!=I BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
2 DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
,I DOMAIN (CURDS, SIDEWALKS,
PERMISSION.
tz SEPARATE
STATq SURCHARGE
PE MITAPPLICATI N; 180OAYS
500
PERMIT UMIT. 1 YEAR, PROVIDED WORK IS STA TEO IN ITHIN 180 DAYS
SEE SACK OF PINK PERMIT FOR MOSS INFORMATION
BE. E St NS AND SU ES RS
'APPLICANT, ON BEHALF OF HIS OR HER S , PAR LESS THE ITY F
DH L
IN INTEREST, AGREES TO:NOEMNI�. DE
EDMONDS WASHINGTON� TGOFFICIALS. L YEES. AN A,ENT FA ANYA-
INSPECTI N FEIP4
ALL CLAIMS FOR DAMAGESOF WHATEVER RE,A ISIN 01 E T R INDIRECTLY
x FjlOM THE ISSUANCE OF THIS PERMIT, I AN E F THIS PER IT SHALL � T BE
RDINAbICE
PLAN CHECK EPOStT
DEEMED TO MODIFY WAIVE OR REDUCE A RE [RE ENT FANY ITY
VAYTHE E F R EANY HOINANCEPR ViSl N.
RE IPT -7,
0 0' NOR LIMIT IN ANY CITY'$ ABILITY
TOTAL AMOUNT DUE
71, -1 s-v
THAT I HAVE HEAD THIS APPL CATION� THAT THE INF RMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
GIVEN S CORRECT. AND THAT I AM THE OWINER� 08 THE DULY AUTHORIZED AGENT OF
Thl� epplicahone, te . pe,eej� eehl,egeld by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
S,eld,19 Olfilill 01 h"Ithe Dlelly: Aed Fees — P.he� ed
TiON; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WiLL BE LEMPLOYTED
WASHINGTON RE ATING 0
,th, ,k ... Ildgld 11 p... peevlded
FOR INSPECTIO14
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
DATE . SIGNED
(425)
AGENT)
�R Zee
771-0220
RELEASED By DATE
EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION AS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCURANCYHHAS BEEN GRANTED, UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
51SS
z
0
0 m
c:
m 0
0
0
m T
-4
z
0 -n
m M
0!;
0
c: v)
C co
To
54 � :
X
_q
x
Z
--I
3:
z
9
0
m
GREGORY S. BURNSIDE
66400100574710998
ATTACHMENT A
Property Description
T BE NORTHEASTERLY 70 POST OF TRACT 8, PLAT OF TALBOT PARK,
AccRoDING TO THE PLAT THEREOF RECORDED IN VOLUME 12 OF PLATS
PAGE 101, IN SNOHOMISH COUNTY, WASHINGTON (AS MEASURED ALONG
NORTHWESTERLY SIDE THEREOF);
TOGETHER WITH TIDELANDS IN FRONT OF, ADJACENT TO, OR
ABUTTING THEREON INCLUDING THAT PORTION OF TIDELANDS LOT 3
IN FRONT OF SAID TRACT.
SITUATE IN THE COUNTY OF SNOHOMISH, STATE OF WASHINGTON.
4�
ATTCHA 1HPI R— 10197
R,
A,