20010590.pdf'7PECEIVED
Wo I PERMIT EXPIRES
us P �R IBMT�-
W UM
CITY OF EDMONDS Z., N E
'0
CONSTRUCTION PERMIT APPLICATION AGGRESS 62' 1
ffol
ADDRESS
CITY ZIP
NAME
.1 ADDRESS
TELEPHONE
�11,b (_469K, W4 1/Z G;, -// 2-7, -3
STATE LICENSE NUMBER EXPIRATION DATE CHECKEDB
OLALT00010 PA ?�Ioi I
PROPERTY TAX ACCOUNT PARCEL NO.
?, - -
sW 3
C] NEW RESIDENTIAL PLUMBING/MECH
M.. I ANCa OR
ADDITION COMMERCIAL] cC!'='.LE .
REMODEL �APARTMENT 0 . s
REPAIR cl RAGING CYOS V)
W
H
C:]
o DEMOLISH TANK
CCA E F NG \WA RENEWAL
3 G RAG T .1��AKINI
ARPOR FE�PLAIN:
Is -
r (TYPE OF USE. BUSINESS OR ACTIVITY)
A,
DESCRIBE WORK TO BE DONE
701 le� r"S
4-0 171E11141y pAlve
/ 1. t, �Poqr_l t.
PLAT NAMEISUBDIVISION NO. I LOT NO. L D NO.74,
L�D FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REGUIRED DEDICATION— FT — W$6W �.d
PRV REQUIRED
YES 0 No 0
R MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
A 4j"- av '014W w 4
FIRE REVIEWED By
DATE
VARIANCE OR CLI SHORELINE OR AORN INSPECTION I P..�..
RE D ETE
E3YES [3NO
SEPA F'V'EV4 f IGN AREA EIGHT
EXE 01. 1 PR..10;;O,A.OWED I PROPOSED
_yp .1
ItIAGE RED IFT.) PROPOSED SETBACKS JFT)
L 'OPOSED FIXIVAS FRONT, UPSIDE PEAR
PA�KING A LANNING REVIEWED BY DATE
10"ICKIDBY ITIPEIkM P(--�_j
[SPECIIALEINSCTOR CACDRANT
PEOU R JAREA 10
YES LET
liWi3iiiESS INSPECTIONS PER UBC 108IFINAL INSPECTION REG'Dj
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING I LoTLoPE' *
14T lj!E
BUILDING
BUILDING
PLAN CHECK NO: 11ESTIVIATI
EE
PLUMBING
PLUMBING
LHANA
M C $C L
MECHANICAL
E
IMT. V
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE P ROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
—DINGIPILL
RA
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION
49 SURCHARGE
PERMIT APPLICATION: IIIDDAYS
PERMIT LIMIT, I YEAR - PROVIDED WoRK,S STARTED WITHIN 180 DAYS
END. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATIDN
-A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
P
END NSlECTI.NlEE
7 DEFEND AND HOLD HARMLESS THE CITY 01
IN INTEREST. AGREES 0 INDEMNIFY.
FROM ANY AND
LANDSCAPING
EDMONDS, WASHINGTON, ITS OFFICIAL S, EMPLOYEES. AND AGENTS
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY ORINDIRECTLY
INSPECTION FEE
FE-CEIPT
s"
FROM THE ISSUANCE OF THIS PER.1T. ISSUANCE OF THIS PERMIT ALL NOT BE
PLAN CHECK DEPOSIT
c
3 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
.1 NOR LIMIT INANYWAYTHECITY SABILITYTO ENFORCE ANYORDINANCE PROVISION.'
TOTAL AMOUNT DUE
RECII M
I HE"EBY ACKI` —EDGE THAT I HAVE lEADT.IS APPLICATION. THAT THE INFORMATION
A�PLI ',A�I�N APPROVAL
GIVEN 15 CORRECT AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
AND LAWS R EGULATINGCDNSTRUC
CALL
T�,
,IEOVINER 1AGnEETOCC WITH CITY STATE
10-4 AND IN D ING THE WORK AUTHOAqED THEREBY NO PERSON WILL BE EMPLOYED
G "d F A,. P.
.,k..d:Fud',y, V
I N VIOLAT 1 0 09 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN S COMPENEATIO.1 1-4AICE AID ACW IB 27
o ICIAIS SIGNATURE DATE
ED
SIGN R 40WNE T, ED
(425)
771-0220
DATE
P EDBI
ATTENTION
EXT 1333
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-
OR
ORIGINAL- ILE YELLOW INSPECT'
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PtNK - OWNER - GOLD - ASSESSOR
592
z
0
,o
0 0
m
0 _11
m M
0
0 Fn
C 0)
v)
0
z
z
0
m
RECORD OF INSPECTIONS
oz
MO
0
0,
0
m
0
z
m
[PERMIT
EXPIRES
us PERM T
ZO'Nc
dITY OF EDMONDS
LIM
N ElER,-ft/-,),!5
1 �7
CONSTRUCTION PERMIT APPLICATION
B
A -RE.
TPAPT.
f
AO
.2
Pi-ATNAME'SUBDIVISION NO
LOT NO
LID NO 74,
LIDFEE$
MAILING ADDRESS
PUBLIC RIGHT OF
WAY IE� .111CIAL 11FIET NAP
qAn5,y
EXISTING —
FROPOSED�
3 o
CITY lIP
ITELIP"IlE
FT
-LINE
NAME.
SIZE
NO, OF FIXTURES
PFV REQUIRED
YES 13 No
IREOUIREDDEDtCATION—
ADDRESS
F �S
IT NIAFKS
OW7NER�ONTRACTOA RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY zip
TELE-014E
ADDRESS
CITY
STATE LICENSE NUMBER
EXPIRATION
CHECKED By
6UI LT eV 010 (26
3 /2
I
PROPERTY TAX ACCOUNT PA�CE�0, -
_70
3
NEW
KUMOING. �ECH
�7
0 Cco_.L,�n -go,
ADDITION
C] REMODEL
C3
0 "ENCE
0 GqAGIN. CYGS
REPAIR IT,
DEMOLISH Cj TANK
0 CHNE.
o GARAGE r-j RETAINNGWALL
z CARPORT —
cl RENEWAL
0 _"��ftPLAIN
p (TYPE OF USE BUSINESS OR ACT
r-,r_-M0 6v(57106 5"Lb
fAMILt fQ5.
LIVE,
Nl"811101
TICAL
ol
STD
D ELLING
UNITS
AS
'BE.
DESCRIBE WORK TO BE DONE
ENGINEERING
FIRE REVIEWED BY
DATE
VARM,
E 04 ADBI
INSPECTI N
RED D
ISO D
POSTED
(3YES ONO
SIGN AREA
HEIGHT
I
ALLOWED 180POSED
ALLOWED PROPOSED
,
,
1E.UIP- BETBA"B IFT)
PROPOSED SETBACKS jFTj.
ALI \o'E..'lG1F
FRONT SIDE FEAR
FRONT UPSIDE REAR
OTA4EA
DATE
DARKN.
JPLANNINGREViEWEDBY
7,
PECIAI,IINSFLIC'I'��A' Vr'MLAa;lAll
QUII H C] Y" I —A
lP`A`0`Q'R'E'S'8 INSPECTIONS PER UBC 108111FINAL INSPECTION REO'01�1
U.-V
VALUATION
FEE,
PLANCHEC,K I Li
_-P,
HEATSOURCE GIAZIND II01 lil
PLAN CHECK NO: 1-110 IAII
It o To
TKIS PERMIT AUTHO IZES ONLY THE WORK NOTED, ONE PERMIT COVERS WORK 10
T P U U C
t: BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON T"lPu"uC
'A
L L a I
DOMAIN (CURBS, SIDEWALKS, ORIVtWAlB. MARQUEES. ETC) WI L Q IF
:5 SEPARATE PERM15giON
PERM A;.
A A
E'.�%Op"-�.'TTA ... .. T" I� bA 6
PERMITLIMT: I YEAH -
SEE BACK OF PINK PERMIT FOR MORE INIO-ATIoN
R1,111.1—
'APPLICANT. ON BEHALF HIS OR HER SPOUSE NERS ASSICIN �
�j
I
IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD H E OF
F
"��
lAlD5CAl
AND
AN
N AND
.. I ffEl. I'E
3 EDMONDS. WASHINGTON ITSOFFICIALS EMPLOYEES AND
ALI.-I.SF..oA.A.�..FW.AIE�E.-I��E,A SNG.:l!
P
INIFECH."
11 -
ECE—
1
FRO. THE ISSUANCE OF IHIS PERM ISSUANCE OF THI T "A '
PLAN Cl�,,cK DIF.Sll
'L A'�
r
A
YORDINANCE
IT Y... ' N
DEEM ` D TO MOD-, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CH
C ` FRO I S '��E
0 NOR LIMIT IN ANYWAY THE CITY S ABILITY TO ENFORCE ANYORDINANCE PROVISION
c
TOTAL AMOUNT DUT,
CTA L
IHEREB ACKNOWLEDGE THAT HAVE READ—SAI'LICAl I ION, THAT THE INFORMATION
T
ICATION APPROVAL
GIVEN IS CORRECT. AND T AT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
�PP
— . IF—.. ulbl., P, —
T I C N FUC
THEOWNER IAGREE 0 COMPLY WITH C17Y AND STATE LAWS REGULATING CQNSTFUC
PERSON ITE EMPLOY E U
CALL
fj�� �Q 0', h,.Ihll DIpuly F 11, PI.d,
ION AND IN DING E WORK AUTHORIZED THERE B�. No WILL
T D TH
I N VIOLATION OF THE LABOR CODE OF I HE STATE OF WASHINGTON RELATING To
FOR INSPECTION
�d :,,d
Ilk—l-g P.. P-1—
woRKmEN COMPENSATION INSURANCE AND RCW IE 27
OniCIALS SIGNATURE DATE
"Pap
DAI� .
(425)
I_
(I �pkh
-1wo
7-71-0220
R, Y
ATTENTION
EXT 1333
L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERIIFI-
ORIGI� L-FILE - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD ASSESSOR
",8
z
0
71
am
a
IT, 0.
__l cl
0 C
m m
CE o
o -n
n
M M
a vi
0
6 Fn
C 0)
c
M
z
0
m