20010551.pdfI DATE RECEIVE%�,
L.-r
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEN ME OF BUSINESS
jof,> <_—I 16VI-riz- SG7-x
zip ITE . LIPHONI
VVN ll'bkol
ii� ol FPERMIT EXPIRES
I USE PERMIT
ZONE NUMBER 0'100 1 _QSS
JOB SUITeAPTO
ADDRESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP sc;
A, P.-I R.q d C:
�h_ uh. P.- II� d c
EXISTING — PROPOSED. N_. P., C
C
RSOIJIREDDEDICATION� FT C
METER SIZE LINE S'27__F7�� PRV REOUIRED
Ir I YES . NO C3
REMARKS
ADDRESS I I OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
(-o-,> s�-, :svVrk_ -1:3-1
CITY ZIP JTQ
WA cNbiol (a 7-4 - �-2-10
NAME
ADDRESS
11"1160 144 AVE A)C &I E (+DO
CITY vi,, zi P �TELEPHONE
W,Qm-w"vlt_LlL Ncft 4ZSj4?3lS-"4
STATE LICENSE NUMBER EXPIRATIOWD
W -tmm I. lcl % 0 ;L- 0� I
PROPERTY TAX ACCOUNT PARCEL NO. . , I
. A54?2-opi-OMM
NEW [3 PLUMBING I MECH
ADDITION o COMPL ANCE OR
CHANGEOFUSE
0 REMODEL 0 SIGN
REPAIR GRADING CY.S C] FlICE
DEMOLISH TANK C] OTHER
oGARAGRE 0 81TAINTNGWALL RENEWAL
CARPO T FGCK�, , E]
TYPE OF USE, BUSINESS OR ACTIVITY) EXPLMN:
NUMBER Z ] NUM EROF ZVI
OF 'WELUN. ARM
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
FIRE REVIEWED BY DATE
r . . ?,- r - o I
VARIANCE OR CU
SHORELINE OR ADB
INSPECT)ION
EGG
I PBOND,
OSTE
RS
[3YE E3NO
SERA REVIEW
SIGN AREA
. HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
E!p I
I
I
LOT COVERAGE
-
REOUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
PA" KING I
RED D PROVIDED
LOT AREA
I PLANNING REVIMEO BY DATE
CH CKE. .1 1 TYPr OU
IF RCU
/NTM;�UIL I CK�, I Oac
BPECIALINSPECTOR JAREA I OCCUPA,��,f-�
IE.0 R [:] YES I LOAD _ _j
PER UBC 108fFINAL
VALUATION
VALUATION
PLAN CHECK FEE
HEAT SOURCE GLAZING I LOT SLOPE %
BUILDING
PLANCHECKNO:()l ,,tSr IVESTED DATE
PLUMBING
ER VERB WORK TO
S P IT GO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I
FRECEIPT
'U "ON ON THE .. L tC
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
D MARQUEES. ETC.) WILL REQUIRE
OMAIN (CURDS. SIDEWALKS. DRIVEWAYS' _ES - ETC) WILL E.U'..
:3 SEPARATE PERMISSION.
t: —
ILtr.
eWE SURCHARGE
PERMIT APPLICATION:ISIID DAYS
PERMIT UNIT: I YEAR . PROVIDED WON K STARTED WITHIN 150 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
P
ENG. INSPECTION FEE
G ARM LESS 'TY F
IN INTEREST. AGREES TO INDEMNIFY. DEPEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
ROM G
D G S .
2 E MONDS.WASHtNGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FR ANYANO
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RED EPT
DEEMED TO MODIFY. WAIVE OR REOUCEANY REQUIREMENTOFANYCITY ORDINANCE
MORLINITIMANY WAYTHE CITY'SABILITY TO ENFORCE ANYORDINANCE PROVISION.'
RE
TOTAL AMOUNT DUE
I HEREBY ACKNOW EDGE THAT: READ T IS APPLICATION, THAT THE INFORMAT10N
APPLICATION APPROVAL
AHAVE
GIVEN IS CORRECT AND THAT M THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T EOWNER I AGREE TOCO.ILY WIT. CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Th., PPI.C.h0h Pii-I 1-9-0 4Y III
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BEL
OF EMP DYED
IN V16LATION OF THE LABOR CODE THE STATE OF WASHINGTON RE ATING TO
FOR rINSPECTION
S
h I`— pl.
WORKMEN S COMPENSATION INSURANCE AND RCW 18 11
OFFICIA NAT DATE
DATE SIGNED
O=
(425)
N��OW4
-IL-OIII,
1 0
771-0220
A
... By
ANENTION
EXT 1333
07,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURELINTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW INSPECTOR gif
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
Z
0
S
0
m
a m
c
M
0
80
c
m m
C
0 -n
m M
a
0
q Fn
c
J_
Z
fill
Z
0
m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
z
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
M
HEATING:
Gas Test .....................
M
Gas Piping .................
C
Equipment .................
Commercial Final d
EXTERIOR SHEATHING
NAILING ....................
M M
FRAMING ........................
W
FIRST FLOOR FRAMING...
INSULATION ..; ................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
z
0.
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................
DATE ECE04 [PERMIT EXPIRES
�84 PERMIT "Oo I
CITY OF EDMONDS NUMBER 0
NDS
'0
N
CONSTRUCTION PERMIT APPLICATION JO Hke lITE'AlT'
A. DR-.
PLAT NAM-SU..'V'.
U 'C' A'
Z ,g
ADDRESS
OWNER -ME-ME OF UElNllB PLAT NAMFJSUSOIVISION NO. I LOT NO, L"' I'D
[A 'VC 11 CILA N3 11. FEE I
MALI GADDRESS ET MAP ;W-P AR� U
'W P
"GHT
UAJ 10" <- 'r 1-v I G Z 3w :UlUC RIGHT 01 WAY PER OFFICIAL STRE
P
P.CN E XSTN.
XISTING PROPOSEO� a
CITY ZIP _LE 0
,,,, ITELEPHONE DEDICATIO
4, LATf LIZ VVO, Clib REQUIRED IDEDMATIC N_ FT — u.=1 0
METER ��E J LINE WE I NO�CFFIXTUIIES PRISEQUIR D
NAME YES 0 NO 0
V )'I t__ V�3 1
CITY z"
S?LA-R L-1-- WA 110610 k
jTl;;'lj (. Z'4 �.Z.Ja
NAME
NAME
L� r --T
ENGINEERING REVIEWEDIDATE
I ADDRESS
so ILILI AVtL VC r.T C-1400
FIRE REVIEWED BY DATE
o/
CIT Y ZIP EPHONE
0
WvD'b6*j v I t-t-t- PA olf
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
REG.,
OyEs ONO
I BOND
POSTED
STATE Ll�CEVE NUMBER
t
a 01
lo�
SERA REVITEMPT
COMPLETE E
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED I P .10BE.
PROPERTY TAX
EKP I
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSEDSET CKS(Fn
FRONT URSIDE, FIEAA
NEW RESIDENJTIAL 0 PLUMBING MECH
ALLOWED PROPOSED
FRONT SIDE REAR
ADDITION C] COMMERCIAL o COMPLIANCE OR
CHANGE OF USE
PARKING
L;7�7141NG
REVIEWED 13Y DATE
0 REMODEL Ej APARTMENT SIGN
REQG I PROVIDED
CD GRADING X
CYDS E] FENCE X FT)
REPAIR FT)
ENI
DEMOLISH 0 TANK OTHER
GA E I RETAININGW�LL 0 RENEWAL
CARRAOGRT C: ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CIIIKE16Y
0 CUMNT
iE It
ITYP
GROUP
NUMBER NUMBEROF
DWELL% G
I
-FITAlrAL
ARE E
OF L�U
1. Siam UNITS
NUMBER
DESCRIBE WORK TO BE DONE
REM�RKS
nAF%q INSPECTIONS PER UBC 1081FINAL INSPECTION REO'E
VALUATION
VALUATION
FEE
FEE
PLAN CHECK FEE
HEAT SOURCE o—A, LOT SLOPE%
No
BUILDING
U L
1 150
PLAN CHECK NO:(
M'
IN.
PLUMBING
LU
'C
ME HAN AL
MECHANtCAL
C
TO
THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
J��'�AD
E
HE ON PRIVATE PER'Y oNL* A"ICDN.1,1F.U.0.1".10NONT EPUILIC
L BE Go PRO
BE
MAR Tr WILL REQUIRE
H�
F ILL
GRADING/FtLL
III .. A EWAL D ""NA' .
IN 'C .. E. $I.
3 4FIATIE PER...
BE SIGN.
APPLICATION: 150 DAYS
LIMIT.- I YEA PROVIDED A SSTARTEDWrrHiN 18GDAYS
PERMIT Wo K I
CHARGE
9TME SURCHARGE
IN FEES
ENG. REVIEW FEES
END REV'E
PERMIT
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
J,
E SOR
TY S
;.AppL,.C�EN.T,.oAI.IEEHALTFoOF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
I
DEFEND AND HOLD HARMLESS THE OF
R ES CITY OF
NSPEr I A FEE
T
ENG. INSPECTION FEE
NO I
LANDSCAPING
ED
N AS INDEMNIFY.
T
GToNi " OFFICIALS. EMPLOYEES, AND A ENTS FROM
2 EDMoI NIL G ANYAND
PECT'oN FEE
INSPECTION FEE
._
AULC"M FOR. BE OF WHATEVER NATURE. ARISING DI RECTLYORINDIRECTLY
SHALL NOT BE
RECEIPT
HIS PERMIT. ISSUANCE OF THIS PERMIT
Fo`Ro6mMETD`T`ol SMSoUtAl PC WoAIV E 0 R REDUC E ANY REOU REM ENT 0 F ANY CfTY ORD] NANC E
PLAN CHECK DEPOSIT
I
IN ANY UTY TO ENFORCE ANY ORDINAN cE PROVISION
Y THE CITY'S ABI
RE I
5- 1
NOR LIMIT
OTAL AMOUNT DUE
ll.C�ATICI HAT THE INFORMATION
APPLICATION APPROVAL 3
=sy EP
S=TLEADNG.ETIHH�ATT:AHMAV,,�RE.ADWTH,.s.A
AUTHDAtZED AGENT OF
E HE PIT 'L�T
WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
jo, 1, nol a pe11 by 11.
F.'.'. -16d
i�a i4.
*.=od:.d
THEOWNER. I AGREE TO COMPLY
IN DOING THWoRK AUTHORIZE ON WILL BE EMPLOYED
"BoN, D THEREBY. NO PERS
I C ELATING TO
R
11
FOR INSPECTION
IN V HE LABOR CODE OF THE STATE OF WASHINGTON
IoLAIR.N OF T
DATE
WORKMEN'S COMPENSATI=NCE AND RCW 16,27.
W�o� DATE SIGNED
(425)
OFF16 &t4VNATWEI. . I
L 3101
[r
771-0220
A ED BY
R ED By
EXT 1333
v, Lo
Al'T4ENTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW - INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER CIOLD -
5'Sa
0
m
V�
10
0
MITI
a
0
o
C
m c)
cA
z
m