20020196.pdfDATE RECEIVED
USEE
CITY OF EDMONDS ZON
CONSTRUCTION PERMIT APPLICATION JOB SUITEIA
ADDRESS
OWNER NAMEINAME OF BUSINESS 15917 72nd Ave W
qlpr. flbpryl PLAT NAMEISUDDIVISIO14 NO. I LOT NO, LID 110,
MAWNGADG,ary� LI FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP AqW.-
AW F A- I
15917 72nd Ave W
CITY ZIP TELEPHONE
'e':R
_E�Mojjds 8026 1425-745-8728 ou fit -elsvirrMor nrensr—
NAMP III MUSS KQ."T9Mfffi- -sififlificA119
ADDRESS
be ADDRSSS
12601 132 Ave NE
CITY 98 ZIP
Kirkland 034
STATE LICENSE NUMBER
gASjkjHgQ52D
PROPERTY TAX ACCOUNT PARCEL NO.
!1 00513300003607
TELEP ONE
425-814-3124
EXPIRATION DATE I CVY
2-16-( t
Regardless of wh ptneir the water system
leg a a
FIR DATE
laqui, on all hot water tanks per
VARIAICEbA C7U _SHQRftINEOAtDS# INSPE
SEPA REVIEW SIGN AREA 13 YES HSIGHT
COMPLETE , EXEMPT ALLOWED FROP111111 ALLOWED , PROPOSED
EXP
0 NSW [A PLUMBING I MECH
LO COVERAGE REQUIRED SETBACKS (rr PROPOS 0 SETBAC
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE IRSEAR
fa AD .IT'..
ri COMPLIANCE OR
HAND BE
CHANGE OF USE
0 E OF U
0 SS .DEII
S
0 SIGN
N
REa PARKING I LOT AREA I PLANNING REVIEWED By DATE
D I PROVIDED
F ENDS
[3 REPAIR 0 GRADING CYGS [] F NCE
( X Fri
X
REMARKS
0 DEMOUSH TANK
0 T..
0 OTHER
GARAGE RETAINING WALL
o CARPORT ROOKERY
o
RENEWAL
[3 RENEWAL
ITYPE OF 111E, BUSINESS On ACTIVITY)l
CHECKEDBY ITYPERM ICYj_ CGUFAN
GR UP
NUMBER NUMBER OF
es OTFG.'e. G
DWEILIIN
CRITICAL
T G
AREAS
S
SPECIAL ulspiaroi
UNITS
NUMBER
R
REQUIRED[] YES
DESCRIBE WORK TO BE DONE
RemoveZrej2lace gas
wateX bdeaterREMARKS
PROGRESS INSPECTIONS PER USIC 108/FINAL INSPECTION REOD
in furnace room X99 40,000 BTU's
( 1,
I
lip I rl;�,
VAWATION $
Description Description I FEE
HEAT SOURCE GLAZING
LOT SLOPE I
115D DATE
EST
Plumbing
PLAN CHECK NO:
Mechanical
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
r
I auto
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
mg
1
omAIN (cuRss,snpEwAuXs,DRwEi I umotmm, ETC.) we.l. naoumE
t: SEPARATE PERMIiSION.
Engr. Review
PIE MITAPPUCATION: ISODAVS
PERMITUMFEly EAR -PROW ED WORK IS STARTED WITHIN '80 DAYS
Engr. Inspection
.... ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS A SIGNS AND SUCCESORS
Traffic Mitigation
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD n ... ... — 1 .1
EDMONDS, WASHINGTON. IT$ OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCi OF THIS PERMIT $HALL NOT BE
Fire Inspection
[ng
DICMIO TO MODIFY WAIVE 01 REDUCE ANY IIEOUI11M1N1 OF ANY CITY ORDINANCE
NOR WIFT IN A THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNERF OR TH DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREW, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECT11
WORKMENS COMPENSATIO==NCS AND RCW 18,27.
SIGNATURE, 013. ion
(425)
W,
771-0220
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
10/01
z
m
am
IT,
0
80
C
rR m
to �
z
0 _n
hin m
0,
0
C:
M 0
Z
z
-4
z
m
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
APPLICATION APPROVAL
This applicaus, I, not a psnair until signed by ffia
S'lldl,g Official or hisibsn DepUty: and Fees are paid, and
ipt I—Re-tognit nrip ... presided.
', e as DArE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
Fl
om
rn
m M.
z
c
g -n
m M
0
2 fil
ca,
M 0
rj)
z
m