20030039.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER NAMEINAME OF BUSINESS
AP �,; , t ---A, W, tl /j _T#1, 0 k9; j- * 10AP1 17
MAILING ADDRESS
_4A -3eq,-!�25
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAME CBLN
R;11." PLO-1641(ill 645
ADDRESS
P 6, Box -713
CITY ZIP TELEPHONE
LviviWOCA q�oq 3 z5) 39- 7
STATE LICENSE NUMBER EXPIRATION DATE C CKEE
61LLSP&010TK Ll-q-09 'AVA
C^ f V_V.Loop
NEW
13 RESIDENTIAL
ADDITION
COMMERCIAL
0 REMODEL
MULTIFAMILY
0 REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
0 ROCKERY
(TYPE - SE. BUSINESS OR ACTWM EXPLAIN:
Pr AIT
'rNUMSER
NUMBER
OF
OF
DWELLING
STORI - -
DESCRIBE WORK TO BE DONE�7.,,t.ji
h
Cook 1;�,e,
,Fee f
Ple 64J A�Ok,
Sk=1BI,NVMECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( FT)
OTHER
0 FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
.IOB
SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
I
LID FEE S
TESCP APPFOvsd
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Pefffln Required
street Use Permit 06q'd
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCEORCU j SHORELINEORADB# INSPECTION BOND
REQ'D POSTED
5 '8 N
LOYEs 13NO S
SEPA REVIEW SIGN AREA Lt HEIGHT
COMPLETE . EXEMPT I ALLOWED . PROPOSED1 ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFISIDE REAR
PARKING LOT AREA PLANNING REVIEWED 13Y DATE
REQ`D I PROVIDED I I
CHECKED BY ITY
]ON
C077 OCCUPANT
I GROUP
TCRITICAL
AREAS
SPECIAL INSPECTION
FREQUiRED
AREA
OCCUPANT
NUMBER
[3 YES
i
LOAD
REMARKS
PROGRESS INSPECTIONS
PER UBC 11081FINAL INSPECTION RE01D
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
$ L -
Dewription FEE Description FEE
. P , 9n
rge
lan Check State Surcharge
Building Permit City Surcharge
Plumbing 5.;-7
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPEFITY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
3 DOMAIN (CUM, SIDEWALKS, DRIVEWAYS. MMQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
I
PERMIT APPLICATION: ISODAYS
L PERMIT uMm I YEAR - PROVIDED WORK IS STAINTEO WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
—
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
)"a
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Foos are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO P ERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknovAedgod In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
SIGNATURE JOYiNER 01
DATE SIGNED
(425)
///-,c /0 2-
�AG &E
LZA � ��
1
771-0220
_M
DATE
,
SED
77TENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPE(ITOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD . ASSESSOR
GREEN ACCOUNTING
-
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
I NINE
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
4A -,�eM5
CITY ZIP ITELEPHONE
NAME
ADDRESS
4� F-
USE
ZONE
JOB
ADDRESS
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1Z .91
PERMIT EXPIRES
PERMIT
NUMBER
r4
SUITE/APT#
PLAT NAME/SUBDMSION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPMV@d
AW Permit Required
street Use Parnift Wd
EXISTING — PROPOSED
Impaction Required
Sidewalk Required
REQUIRED DEDICATION- FT
_TNq.�
Underground
Wking required
METER SIZE
LINE SIZ�
OF FIXTU RES
PRV REQUIRED
YES13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
NAME CBL#
Bi I G ENGINEERING REVIEWED BY DATE
ADDRESS
P0. —713 FIRE REVIEWED BY DATE U1
ZIP TTEP
CITY ELEPHONE
( 2 � -7 IE
L 4��o >
v c.) VARIANCE OR CU SHORELINE OR ADB# I —INSPECTION BOND
C� Y
fj COMPLETE . EXEMPT WED . PRO
STATE LICENSE NUMBER EXPIRATION DATE C ECKED REOD POSTED
BILL 5PG>C? i o TK Li — 9 L/ SEPA REVIEW SIGN AR . EA 10YEs 13NO $ HEIGHT
PROPEF17Y TAX ACCOUNT PARCEL NO. . — I ALLO pnqF:n I ALLOWED , PROP
NEW
RESIDENTIAL
N(PLUMBINgIMECH
ADDITION
C OMMERCIAL
COMPLIANCE OR
El CHANGE OF USE
REMOD�L
MULTIFAMILY
0 SIGN
REPAIR
GRADWG PfDS
FENCE
X_
DEMOLISI-i.
TANK
G
OTHER
1:1 GARAGE
CARPOW
�
RETAINING W LL
1:1 ROCKERY
FIR SPRINKLER
E
FIREALARM_
(TYPE WqE. 13USINESS OR ACITMY) EXPLAIN:
J10.0 A 21-
a&
NUMBER
OF
it
UMBER OF
DWELLING
I
CRITICAL
AREAS
I
STORIES (;�
NUMBER
DESCRIBE WORK TO
BE DONEI-,,, tall het�,
905
LOT COVERAGE I REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED I FRONT SIDE REAR FRONT LIR SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY
REO'D I
CHECKED BY ITYP I NS RU ION
SPECIAL INSPECTION JAREA
REQUIRED
REMARKS
INSPECTIONS PER UBC 1108/FINAL
DATE a
116
OCCUPANT
GROUP
OCCUPANT'
LOAD
ISPECTION RECtD
VALUATION
$
Description FEE 'Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
C
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
2
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILI IWID011Y87-
PERMIT UMM I YEM - PROVIDED WOR 18 STAFrrE0 WffHIM 180 DAYS engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. Deposit
RIF e
"APPLICANT, ON BEK41F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review
S
0
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Receipt #
4;
2170"'L
Total Amt. Duo
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE 01: THIS PERMIT SHALL NOT BE
4 Landscapeinsp.
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVI810N."
41 Recording Fee
ec
Receipt #
ww=
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION A111212"AftA711
U ADDUQUAll
GIVEN 18 CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a peffnit until signed by the
TIOW. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 0111clal or his/her Deputy: and Fees ara-pald, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. A. OFFICIALS SIGNATURE DKiE
SIGNATURE (OVNER 0 IA25)
SIGNED
f ltv� (t_
771-0220 �Tifi C-PASED DATE
ATTENTION EXT 13,33
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE INAPE&R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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