20030042 (2).pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O�ER NAME/NAME OF BUSINESS
AA k&% ,
"IN a
MAILING ADDRESS
go / 1i
/oLl 0�,__
CITY ZIP TELEPHONE
t1_4 fvwel� qf,;o (g,06) 5 y 6 - c
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
CBL N
Vo, y
APDRESS
*74xi 57vo '5).S.--*
CITY ZIP TELF,�ONFL,
L�1,4 wN 19p,1b
STATE LICENSE NUMBER EXPIRIn
IN
f P 14 e)q 2 e wk
PROPERTY TAX AWOUNT PARCEL NO.
L/16
j1q 1-16
NEW jr� ESIDENTIAL _W/PLUMBING MECH
COMPLIANCE OR
ADDITION COMMERCIAL 0 CHANGE OF USE
REMODEL MULTIFAMILY 1:1 SIGN
LERMIT EKPIRES
P
SE PE14MIT /i
C
ZONE NUMBER /Q C 1; -
JOB SUITEIAPT#
JC
[ACIDDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
TESCP APPrO"d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ANY PerrrJt Required
Street Use Permit R0q'd
EXISTING PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
UnderWound
Wiring required
METER SIZE
LINE SIZE NO. OF FIXTURES
PRV REQUIRED
I I
YES D NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
F ( j R.S�` - T A � TT TM ECDC 19.30.020
ENGINEERING REV&MS"I"
SILALLL BE INSTALLED NEAR
FIRE REVIEWED BY DATE
VARIANCE OR cu SHORELINEORADBO I INSPECTION I BOND
By REO'D POSTED
SEPA REMVIEW SIGN AREA 13YES 13NO 1$ HEIGHT
Lo
COMPLETE . EXEMPT ALLOWED , PROPOSED [ 'ALLOWED I PROPOSED
REPAIR
[3 GRADING
CYDS
1:3
FENCE
( _x FT)
[:3 DEMOLISH
0 TANK
[3
OTHER
r GARAGE
I nnor
rl RETAININGWALL
Ch-VIWFRV
11
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) E�"
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES [UNITS NUMBER Al/
DESCRIBE WORKTO BE DONE Ije j
wot4el _-5e.,a
f0 WN
a
z
LOT COVERAGE AA% BACKS (FT)
E DE REAR
LOW ' �11 9 SI
ALLOWED PROPqOWM LWfi - bW DIt I AY,11'RE Z
LINE SITEN`rERSTHFI.Iuri5tigC,
DATE
PARKING LOT AREA I PLANNING REVIEWED BY
REO'D PROVIDED L=
r
FRMARKS
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
em�
THIS PERMIT AUTHORUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. AMY CONSTRUCTION ON THE PUBLIC
DOMN (CURBS, SIDEWALKS, DRIVITNAVS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: ISO DAYS
PERMIT UMrr I YEAR - PROVIDED WORK 16 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAPA ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMffNSATI0,jVSyRANCE AND RCW 18.27.
rE SIGNED
CHECKED BY ITYPE P(F COIjST7.UGIIUN I %�;T
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
2
$
1
Descdptlon
FEE
Description
FEE
Plan Check
State Surcharge
BuildingPermit
City Surcharge
17
Plumbing
- 477 =7_
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building offictai or histher Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
(425)
771-0220 RELEASED BY
ATTENTION MA I I
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 - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL PROJECT APPROVAL FORM
TO:
DATE:
z
0
=i 9
us ;�
a M
c
ma
0
80
c
-1 r.
2: M
MZ
10 -1
c
co
0 -n
n
mm
0
0
0 M
C (a
c ch
M 0
z
4
ra
z
9
0
m
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date si
ocaprvi.doc.l:tejM:bldg:formsIO/OI
0
4
DATE RECEIVED
.q
101 PERMIT EXPIRES
JSE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITEIAPT#
CONSTRUCTIO14 PERMIT APPLICATION ADDRESS �)%)j I
OVXER NAMEINAME OF BUSINESS
A A I I PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
TESCP Appmed 13
Lt 0" P PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Rewired
I - L--.j Street Use Permit Wd
,
CITY ZIP TELEPHONE EXISTING PROPOSED-- 111SPOCton Required
Sidewalk Required
5LI6- REQUIRED DEDICATION— FT Undergmund
jVV'9 W'7'�— Wking required 13
NAME METER SIZE LIN��. OF FIXTURES PRV REQUIRED
F3
YEsI3 NO 13
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP ONE
NAME CBLN
P SU'0;
VA. LA ENGINEERING REVIEWPOBy
A PRESSURE REQUIL RN�&MV)
AAQDRESS
'R
F.*17--- . � F__I
AW I S '5
FIRE REVIEWED BY THE WATER SHUTOFFDATE
CITY ZIP TELFJ�9$1,E
&-lb
1_/ Lie.
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIR �TE�_ CUSQUD BY REO'D POSTED
'Tj
P P 4)qqe nA AD AREA [3YEs 13NO $ HEIGHT
-D4ypj SEPA REVIEW SIGN
PROPERTY TAX—AWO PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PRO POSED
,
EXP 11R211A i 2
LOT COVERAGE 6 frfffiprf IDIACKS (FTI
NEW ir'RESIDENTIAL W01PLUMBING / MECH ALLOWED Ell E REAR
PROPOSEIL� T1
COMPLIANCE OR S11MI-L BE INSTALLE.1, GN I E
ADDITION COMMERCIAL CHANGE OF USE 11 Q 111P *
z
PARKING E M96'Eil" 'dATE
REMODEL MUL11FAMILY S113N RECID I PROVIDED
GRADING FENCE X
REPAIR CYDS FT) REMARKS
DEMOLISH TANK OTHER
GARAGE o RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM ,3
(TYPE OF USE, BUSINESS OR ACTIVITY11 EXP CHECKED BY ITYPE=ION OCCUPT 3
I M, GROUP
NUMBER NUMBER OF CRITICAL OCCUPANT
OF DWELLING AREAS SPECIAL INSPE N AREA LOAD
Ah'4--
STORIES UNITS MBER REQUIRED 0 YES
DESCRIBE WORK TO BE DONE k/e W&q 4el �5e--1aj4L&_ REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECeD
Me 1.-0, Amp
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: J VESTED DATE Plumbing 777V
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONOt ANY CONSTRUCTION ON THE PUBILIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATIOlk 130DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I
"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 CrTy OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE.OF THIS PERMIT
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
WAY THE ABILITY 70 ENFORC E ANY,ORDINANCE PROVISION.-
NOR LIMIT IN ANY CITYEI
. Recording Fee Receipt #
L2/ .1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN '18 CGRRECM . AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building OM, clal or his/her Deputy: and Fees ate paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recelpt Is acknowledged In space provided.
WORKMMCOM �SATIOSM^LRANCE AND RCW 18.27. OFFICIALS SIGIJIATURE DATE
-
SIGNA IGNED 1A
DITE S %-W'25) - Lv13
TLEASED �BY�
771-0220 LTATE
L
RE
A'17TENTION ftx I I ;jj 4=Z-
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 - INSPECTORT
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSO&
04/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
z
0
:1
0
m