20030044.pdf13
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Mb a ti 4n; n Tra osDoAkom LLC
MAILING ADDRESS
110 A Ins it)
OPOW15
CITY ZIP
qfo,;o 1
TELEPHONE
-7
4Fd#mrdj-
7.?- 51
NAME
ADDRESS
CITY ZIP
ITELEPHONE
NAME ICBL
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
ROPEJnY TAX ACCOUNT PARCEL NO.
1:1 NEW
RESIDENTIAL
PLUMBING/MECH
0 ADDITION
OMMERCtAL
COMPLIANCE OR
PIC
CHANGE OF USE
1:1 REMODEL
MULTIFAMILY
?4M40
jgn- SIGN
REPAIR
GRADING CYOS
FENCE X
FI)
DEMOLISH
13 TANK
OTHER
GARAGE
-1 RETAJNINGWALL
13
F RE SPRINKLER
CARPORT
RccKEny
FIRE ALARM
M?E OF USE, BUSINESS oniAcTiviaY) EXPLAIN:
C)jCF#;Ce Use
e6ordi'm le
'5 917 a4ld SrI6kj6&t*d p^Psy,*,aqis
NUMBER
NUMBER OF
CRITICA
OF
DWELLING
AIIA
AREAS
I
STORIES
UNITS
NUMBE'la"A
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
lw
PLAN CHECK
VESTED DATE
Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTV ONLY. ANY CONSTROCTION ON THE PU13UC
Grading
X DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 180 DAYS
a. PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
gzngr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAN7, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
31 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
I HEREBY 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-
CALL
/1
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
B.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S SqMEI�NSATION INSURANCE AND RCW` 18.27.
SIG=WNE�,
R
DATE SIGNED
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1A
1-11,25)
771-0220
'74SE
'�4ut
ATTENTION
Off 133:3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU AiWING
5 COPIES
VlKa I I PERMIT EXPIRES
USE PERMIT
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gy NUMBE2L5�44 -6,C1'y7__
JOB SUI APT#
ADDRES
1:
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP APPfDvsd
AW PernJI Required
Street Use Permit Req'd
EXISTING - PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
undergmund
Wiring (squired 13
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
I
F"�O*
YES E3 NO E3 z
REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE I
BY DATE
FIRE REVIEWED BY DATE
rA.
VARIANCE OR CUI
SHORELINE OR AD130
I INSPECTION
BOND
os - 15";
EQ'D
1 Rl 13NO
XG
POSTED
1$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE , EXEMPT
:_XP Ix
ALLOVED PROPOSI�D
a
14164 Ott!
ALLOWED PROPOST
41
1 1414
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIFISIDE REAR
Z3
PARKING
REO'D I PROVIQED
LOT AREA
I P(t'jNG R
R
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0
-1 DATE
Q.
I
CHECKED BY ITYPE OF C TRUCTi COW" OCCUPANT
j7-1 GROUP
ZM-19'7 I If / 6
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED r] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER LIBC 10111MINAL INSPECTION REG'D I
$ -- I
Description FEE Description FEE
Plan Check State Surcharge
I City Surcharge 6 -
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
JCATION APPROVAL
. il I nod bV the
aU�� "in un" 5
I Isr-ho, Do pwV"and Foom are paid, and
iockriowigued Irn space provided. j
Ify DATE
OR�GINAL - FILE - YELLOW - INSPE�TO
P NK - OWNER - GOLD - ASSESSOR
GREEN - ACCOUNTING
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"FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FAILED FINAL INSPECTION - OUTSTANPINU MUM
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES -GRANT FINAL PROJECT APPROVAL
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