20000986.pdfDATE RECEIVED�
[PPERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOE
ADDRESS r
�j I I L'o
OWNER NAMEINAME OF BUSINESS 'LIT NIME11LEIM"ElON N. I LOT NO, LID NO.
(12ac,12 gL FEE E
IJAILING ADDRESS u
PUBLIC RIG"' 01 WAY PER 0111CIAL STREET MAP 0
0
q11
c - EXISTING — PROPOSED
CITY
REQUIRED DEDICATION— FT p
r--Dk(L) NO. OF FIXTURES PRV REQUIRED
NAM YES 0 No 0
'4111
L
REMARKS
ADDRESS OWNERICONTRACTOR RESPONSIBLE .A EROSION CONTROUDRAINAGE
6 / ��,Z, .
CITY ZIP
j��Lj,(Ljj
NAME
NAML
END 'NEE"
Co ENGINEERING DATE
'BODY
ADDRESS
FIRE REVIEWED BY DATE
IRE E
A "
CITY ZIP TELEPHONE
W1-
0 1 _7�
C"o 7?1 gN OR ADBY EC�ION
SHORELINE
VA. N SORG. �2ND
VARIANCE OR CU
Fl0_AU.ATS V_ -
STATE LICENSE NUMBER EXPIRATION GAIE CHECXED By EG
K- ?"m FlYEs riwo
_ �E
1��
SERA A VIEW SIGN AREA HEIGHT
COMPLETE txF T ALLOWED PROPOSED ALLOWED PROPOSED
�V
pAZf=IT XP , MP (V
EXP "I � I - 26
LOT COVERAGE REQUIRED SETBACKS IFT.) PROPOSED STBACKS(FT)
53/pLUMBING MECH A T SIDE REAR FRONT URSIDE FEAR
0 NEW E�/RESQENIIAL
��O;D
COMPLIANCE OR I 7A , 5" j 5"
0 ADDITION 0 COMMERCIAL C____ -1 ---
lARjKtNG LO T AREA ANNING REVIEWED BY DATE
_TpL
ff"REMODEL APARTMENT F1 SIGN FFaD PROVIDED
1 —1 7/
I
0 IENCE
0 REPAIR X FT) EMA.KS
X
o OTHER
0 DEMOLISH TANK
0 GARAGE RETAIINNGWALL REN—L
0
CARPORT ROD E�
CF _�TYPE OF USE, BUSINItSSOR C iTY)EXPLAIN.
CHECKFDIIY ITYPEOICONSTAll
TI.N
OCCUPANX
GO GROUP
NUMBER
SPECIALMSPECTOR
JAREA CUPANT
L AD
OF
STORIES
REQUIRED [] YES
DESCRIBE WORK TO BE 0 REMARKS
on tMQo=r.TInNA PER UBC 108/FINAL INSPECTION REO'
VALUATION FEE
I 6011WA hCX I S h -V,-7
KJ46
76
6,41,WW7
t"'
PLAN CHECK FEE
ATSOURCE, LOT SLOPE %
BUILDING
I
PLUMBING
Flo
' No
P AN CHECK NO:
P AN .-C
r)
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T. B FE MIT AUTHORIZES '
-
I_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
E ONE ON PRIVATE F.
GRADINGIFILL
WAY
DOMAIN ICURBS, SIDEWALKS, DRIVE S, MARQUEES, ETC.) WILL REQUIRE
.MAIN U... ' S'.E`M
SEPARATE PERMISSION.
L
STATE SURCHARGE
PE N: 1BODAYS
PEFU
AM
6. 00
P ENMT L' ARMITAPPLICATI
ERMIT LIMIT, I YEA - PROVIDED WORK IS STARTED WITHIN 180 DAYS
MIT YEAR
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
BE BACK ,
(A -APPLICANT ON BEHALF F HIS OR HER SPOUSE� HEIRS, ASSIGNS AND SUCCESORS
N BEHALF OF
F�S T DEFEND AND HOLD HARMLESS THE CITY OF
IN INTEREST. AGREES 0
ENG, INSPECTION FEE
LANDSCAPING
:NDEMNIFY
I E A 4INGTONO TS OFFICIALS. EMPLOYEES, AND AGENTS FRO. ANYANO
FA_ND, W E, I
OMONDS WASI
FOR DAMAGES OF WHATEVEP NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
— RECEIPT
ALLCI-AIMS
X FRO. THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
LICE ANY REQUIREMENT 01 AN
MODIFY, WAIVE OR RED ' ITY ORDINANCE
EEMEDT NIEFF.11SION.'
AEG
-7
N ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINA
NOFLJMITOl
TOTAL A OUNT DUE
1�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS COFIREO�EEANO.THATFI AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Thl b,
THE OWN. I ACH TO . LY WITH CITY AND STATE LAWS REGULATING CONSTRUC
YEA
CALL
'' 1� N L
TION IND RED 0 PERSON WILL BE EMPLO
AND'ON 0 NG THE WORN AUTHORIZED T
GT A RE ATING 0
WASAIN T
FOR INSPECTION
.pt! ow.dw.
,
IN OLAT DIF THE LABOR CODE OF THE S ATE OF
V,;
PENSATION INSURANCE AND ACP� 18,27.
OFFICIALS SIGNATURE DATE
A TI_ j DATE SIGNED/
(425)
/17-A-Mm-
771-0220
RELEASE DATE
EXT1333
ON
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
YELLOW - INSPECTOR
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI�
ORIGINAL - FILE
GOLD -ASSESSOR
A FINAL
BEEN GRANTED, UBC SECTION 109
FAX
"HK OWNER
CATE OF OCCUPANCY HAS
519S
z
m
a m
c:
ma
0
80
C
-4 c
x
m m
z
jo 4
CE
c:
O.n
.n
m M
00-
0
C)
C
M 0
z
z
m
F
RECORD OF INSPECTIONS
7
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retainirig Wall
1A
Stab Insulation ..........
-n
PLUMBING:
DIV
Underground
C
M 0
��5�
Rough4n .... . ........
—L2=,:LC1
00,
Commercial Final
M
HEATING:
GasTest .................
Gas Piping .................
Equipment .................
IT, IR
Commercial Final
----------------
0 00
0
1
0
EXTERIOR SHEATHING
th,
NAILING ......................
C (a
M O�
Z
FRAMING........................
FIRST FLOOR FRAMING
YAS
I, -Z 6
INSULATION
...................
Floor Insulation
Wall Insulation
V)
Z�
Ceiling Insulation
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............
-- --
- -----
PATE RECEIVED
[PERMIT EXPIRES
USES PERMIT 2
CITY OF EDMONDS
ZON NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADD ... ab� LU _4
'S
OWNER NIMEiNIAME 01 BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NG* 11 NO,
cod-
LID FEE S
In
MAILING ADDR
Ct '/Es/
TE—App-1 u
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAI —p— ... .. Q
V.. P-1 F.0 0
I P E EPHONE
EX1S ING— PROPOSED 0
61'
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE No. OF FIXTURES PAV REQUIRED
NAME4YES
0 No 0 -
ADDRESS
REMARKS
OWNEFVCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDBAINAGE 0
I u
CIT E1..NE
�5
NAME
ENGINEERING DATE
ADDRESS
CITY zip TELEPHONE
FIRE REVIEWED BY DATE
It
z
Y'\
VARIANCE OR CU SHORELINE OR AOB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATKIN UAI t
REC-D POSTED
V�_ 1�� — OYES arm
. _ 64
0
m
IR411Twc—
TV
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PEI POSED ALLOW 0 PROPOSED
i
7T, o?;, �220_9
EXP N&
m
- REQUIRED SETBACKS (FM) PFOPOIEDIETIACIISIFTI I
LOT COVERAGE RONT LIR SIDE BEAR
SIDE BEAR F'
[glPLUMBING M
0 NEW CH
ALLOWED "ZOIEO FRONT M
m
o COMPLIANCE OR
0 ADDITION CHANGE OF USE
35o, 74' 5' 1'� All
By
0
0
Mo
C�f;]RE DEL 0 SIGN
PLANNING REVIEWED
RED( D
C*"-
C,
C ��:
m
FENCE
C3 REPAIR 0 , — — FT)
I
REMARKS
m
10
o OTHER
DEMOLISH TANK
c
>
J
"A"A". ' 10N. RENEWAL
ZI C3 CARPORT 0 REC,'PlY 0
i2 I
o"n
n
TION cup
COn I PA
r ZITYI EXPLAIN 'HOCKED By SIT
NUMBER' . .... CAL
NUMBER F
DWELLING AREAS
� A
�TYPRE ;CONS�
E_
F _,CIALNSPECTO REA ... ...
�JRED L.A.
rn m
OF R
STORIES UNITS NUMBE
.
U
REQUIRED 0 YES
0 YES
0
DESCRIBE WORK TO BE DO
REMARKS 06 REO'D g
INSPECTIONS PER UBC 108/FINAL SPE�;P
00 r-
c 'm
4ml Ad'12 f, fv)
PROGRESS
'cr, v)
k
&2a)-r' 0
0
VALUATION
FEE
PLAN CHECK FEE
ca
AT SOURCE LOTSLOPE'
GLAZI
BUtLDING
P AN CHECK NU: 'E TED DATE
T,
PLUMBING
m
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. TH IS PERMIT COVERS WORK TO
TION ON THE PUBLIC
BE DONE ON PRIVATE PROPER NY TEUC
YS' =U S, ETC,) WILL REQUIRE
GRADINGIFILL
r,ALKS,=AA
DOMAIN (CURBS, SIDEI SEPARATE PERMISSIOM
STATE SURCHARGE
PERMIT APPLACATION: 180 DAYS
57 00
PERMIT LIMIT-. I YEAR - PROVIDED WORK IS STARTED WITHIN ISODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
N"' DEPEND AND HOLD HARMLESS THE CITY OF
IN INO�IRE.'.T AIE%T'.T�O Nt�"M - ROM ANY AND
: EMPLOYEES, AND AGENTS F
LANDSCAPIN
INSPECTION FEE
2 E M BE ASH'N T OFFICIALS.
,_,.E,.R.A.A'E..1-.ATEVER �ATUIIE,A���INGDIRECTLN��,,,,,-,,---,
IF A' C BE
2
FILL. THE'.IJANGE 0, THIS PERMIT. HALL NOT
FK ISSUANCE OF THIS PERMIT S
OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
E SIT
PLAN CHECK 0 PO 2
D T MODIFY, WAIVE
SEMED 0 LITY TO ENFORCE ANY ORDINANCE PROVISION
0 NOR LIMIT IN ANY WAY THE CITY'S ABI
REG PT
TOTAL AMOUNT DUE 7
I NEESE ACKNOWLEDGE THAT I HAVE RE Ap,'GAT��OLNY., THAT THE IEI.101M ION
Y ADTHtS.F
I APPLICATION APPROVAL
'E6 AUTHOR'Z AGEAT
GIVEN I CORRECT; AND THAT I AM THE OWNS NSNT OF
STATE LAWS REGULATING GO
S MPL ITH NRD' THIC
Thi, ppii,,I,,n I, not 0 P111n Until 51999d "Y 1,
CALL SuMing 01ficial 01 Ini'l-I ul, iind F01IN110 P81d, nd
THE OWNS TOGO
R IAGREE ORK A H E B 0 E EM E�
TION, AND IN DOING THE W THERE YN PERSON WILLS API
BE ATING TO
-Pt vi .�knKdpd in iinn d.d.
FOR INSPECTION
IN VIOLATIO14 OF THE LAS 1, GODEORIZTHOE STATE OF W.AEHIN.T.N
DATE
FCW �"
WORKME CON EN tNSURANCEAND 18.27, —
DATE SIGNED
OFFICIALS SIGNATURE
(4,25)
771-0220 RELEASE
&TENTION
EXT1333 �j
c'u
TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL, 771-0221
IT IS UNLAWFUL
NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORIGINAL -FILE YELLOW - INSPECTOR
A FINAL
OFIOCCUPANCY HAS BEEN GAANTED� LED SECTION 109
PINK, OWNER - GOLD - ASSESSOR
FA x
CATE