20030062.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
_P,eCL4� LA &
MAILING ADDRESS
NAME
ADDRESS
CITY
NAME
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ADDRESS
C
A
STATE LICENSE NUMBER
S&k
ZIP I TELEPHONE
ZIP ITELEPHONE
PROPERTY TAX ACCOUNT PARCEL NO.
TELEPHONE
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KINEW
f&—O\ RESIDENTIAL
13 ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
0 REPAIR
GRADING CYDS
DEMOLISH
0 TANK
GARAGE
CARPORT
[3 RETAINING WALL
ROCKERY
UWE OF USE, BUSINESS OR ACTIVITYI EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
FA
UNITS
DESCRIBE WORK TO BE DONE
USE
ZONE
JOB
ADDRESS / e?7
PLAT NAME/SUBDIVISION NO,
I PERMIT EXPIRES
PERMIT 00�
NUMBER
SUITE/APT#
il.� (i , if 0' '( �- I'
LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW ParMit Required
Streal Use Poffnh Req'd
EXISTING - PROPOSED
Inspectio" Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
Wiringroquired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 N 0 13
z
I
REMARKS
OWNER/J@yg"CTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
I Pd4l Ifilir.7 I reqtdredontuel-buf-iiingi-i-p-p-1-1-pnce
F0 unheaW spaces. TYIVAC 8-1-5-1.7
ENGINE DATi
W_ LUMBING / MECH
COMPLIANCE OR
13 CHANGE OF USE
[] SIGN
EiFENCE
( — X—FT)
OTHER
F RE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
0
FIRE REVIEWED BY
VARIANCE (oft,
SEPA REVIA
COMPLETE. EXEA
LOT COVERAGE I REQUIRED SETO.
ALLOWED PROPOSED I FRONT SIDE
REO'D
DATE I Mug":
BOND
POSTED
HEIGHT
) . PROPOSED
PROPOSED SETBACKS (Fr.)
FRONT LIR SIDE REAR
12
-Fa �ME
T� zrl-"Fa;
CHECKED BY I TYPE C
OCCUPAY
JARE GR f_t�5
SPECIAL INSPECTION A OCCUPANT
REQUIRED YES LOAD
REMARKS
1PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
$ F
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
1
Building Permit
City Surcharge
K NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
lz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISODAYS
CL PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due 7_q
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt # 2LL2_
I HERE13Y 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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or hisfher Deputy: and Fees are paid. and
LA13OR C
IN VIOLATION OF ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
COYHE
WORKMEN'S NSA)Vfr
,WRANCE AND RCW '18,27.
OFFICIA�S SIG, URE DATE
SIG OAT . QIGNED
1425)
7 -0
71 220
-RELEA
ad-61 __
AITENTION
Off 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 - YELLON - 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
DATE RECEIVED PERMIT EXPIRES
/ USE PERMIT 1003
CITY OF EDMONDS ZONE NUMBER
'6'
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
o_-a� w & 6 ob Sand
MAILING ADDRESS j
(q -1 a � IS Ave,
CITY ZIP TELEPHONE
�rrifnryyv-, 9-mw I
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
ADDRESS
CBL #
C ZIP 4 1 TELEPHONE
a C)b
STATE LICENSE NUMBER FXPI 0 ROT I
z
or
WMEW 's ffjj
PROPERTY TAX ACCOUNT PARCEL NO.
PYNEW
RESIDENTIAL
95 LUMBING / MECH
ADDMON
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
x FI)
0 DEMOLISH
TANK
o OTHER
GARAGE
RETAININGWALL
0
0 FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
UWE OF USE, BUSINESS OR ACTIV" EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
STORIES
DWELLING
UNITS
AREAS
I -NUMBER
DESCR18E WORK TO BE DONE
Wo! 4 W! _R_1 6111 DI W
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DOME ON PRIVATE PROPERTY ONLM ANY CONSTRUCTION ON THE PUBLIC
M
M DOMAIN (CUPM, SIDEWALKS, DRIVEWAYS, UAnQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATIOW 180 DAYS
PEnLiff uurp i YEM - PRWDED WORK 19 STARTED wrmim iso DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREE$ TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR 6i"GES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIFIECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF4 WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
.0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 13 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 OFJHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S CO&VENS90N
,01flURMC AND RCW 18.27.
DATE SIGNED
ATTEN ION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 PINK -OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
JOB SUITEIAPT#
ADDRESS lq7-4
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approw
RW PairrAt Requkod
stroet uss Pannh Reqv
EXISTING — PROPOSED
Inspect1cm ReQtked
REQUIRA�DICATN Z�. FTg:E
a
METERbliE_"L 114_�k_El yP',.Pyijiiu�kL1___fflLMU
E
FIRE REVIEWED BY untar I tu DATE I I"
VA—RIANCE OR CU SHORELINE OR ADB# I INSPECTION 1$ BOND
REO'D POSTED
13YEs 13NO 1'.
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED � PROPOSED
EXP _L
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
REOPD
DE REAR
DIE
CHECKED BY
TYPE S
CfT
ocu U
I
I GROU
SPECIAL INSPECTION
AREA
OCCUPANT
ILOAD
REQUIRED r" YES
REMARKS
PROGRESS INSPECTIONS PER UBC 1013/FINAL INSPEC71ON REG'D
Description.
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
0.-
Grading
Engir. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
-79(
Recording Fee
Receipt # 12�11:2_
CALL
FOR INSPECTION
1A0
1,425)
771-0220
M 1333
APPLICATION APPROVAL
This application Is not a permit untu signed by the d
Building Officis] or his/her Deputy: end Fees are paid, an
receipt Is ackriowtodged in sp&w provided.
OFFICI S; SIGWAXURE DATE
RELEASED BY DArE
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