20030074.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP I TELEPHONE
AME
ADDRESS
CITY ZIP . I TELEPHONE
E C�Ozw%
ADDRESS
CITY ZIP I TELEPHONE
1pr�_ I f L-r,—
I UF�" I"IA—TlrN
STATE LICENSE NUMBER
DATE
mQQffQ8&xm
'a-Ql
PROPERTY TAX ACCOUNT PARCEL NO.
Q-�� I 166
NEW
RESIDENTIAL
0 PLUMBING / MECH
0 ADDITION
COMMERCIAL
o COMPLIANCE 08
CHANGE OF USE
0 REMODEL
0 APARTMENT
0 SIGN
0 REPAIR
0 GRADING
CYDS
0 FENCE
_X FT)
0 DEMOLISH
0 TANK
rp
o GARAGE
CARPORT
0 RETAININGWALL
0 RENEWAL
_EY
ROCK L
(TYPE OF USE, BUSINESS
OR ACTIVITY) EXPLAIN:
w
ku 1,24km
AQ
NUMBER
OF
NUMBER OF
DWELLING
A//
CRITICAL
AREAS Nlk
STORIES e'��
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
if ALI^ VESTED DATE
9/pz� 11—*N I f I I/
PERMIT EXPIRES
USE PERMIT
ZONE 16 NUMEIERA091�vzz..]
JOB SUITE/APT#
RESS tr-if AVF EDMOIqD54 IIIL
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIP Approved 0
AW Permit Required 0
Street Use Permit Req'd 0
EXISTING � PROPOSED
inspection Required 0
SNowalk Required 0
REQUIRED DEDICATION— FT
Underground
Wiring required r*1
METER SIZE
LINE SIZE
NO. OF FIXTURES
PPIV REQUIRED
I
I
YES E3 No E3
z
E
w
REMARKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
a
z
us
ENGINEERING PIEVIEWED/DATE
FIRE REYIP&P By DATE
Uj
0 2�
cc
M
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BON
REO'D
POSTED
I
YES [3 NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED,...
ALLOWED ROPOSED
EXP I
,
LOT COVERAGE
REQUIRED SMACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT , L/R SIDE REAR
bY DATE
PARKING
LOT AREA
PLANNING REVIEWED
P
REO'D I PROVIDED
I
I
CHECKEDBY jTYPE9r-jf.O?rMUCTI1N Cninim OGG IAN T
,V
'N GRO P
SPECIAL INSPECTOR JAREA OCCUPANT
REQUIRED 0 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION
PLAN CHECK, FEE
BUILDING
01 irkmlm�_
VALUATION
FEE
rL.04114
10-Vw__ - MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
J
SEPARATE PERMISSION. ;_ff �MCURGE
PERMIT APPLICATION: 180 DAYS 7
W .....
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS ;744ETE FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
—;;; WIE ION FEE
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESO
PIS L
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
3 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE
4x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY RECEIPT
Z FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE 2CEE� 65.
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' MCEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPRO
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 his/her Deputy: and Foos are paid. and
IN VIOLATION OF THE LABO5_C,0DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSA3�)Q INSLVANCE AND RCW 18,27. IAL AT DAT
NATURE (OWt VR� A NT) DATE SIGNED (425)
05am
Y
771-0220 TRELEBY 'I DATE
ATTVNTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1 ww,
771-022 T_
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
5198
a
z
a
_j
Y/ I
0
FINAL PROJECT APPROVAL FORM
TO: —
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: _FIRE DEPARTNINT DATE
ENGINEERING DIVISION DATE-
-PLANNING DIVISION DATE—'
nEASRSMN
711-f6 a Pap (-Z-6
PROJECT_.1(.,,_LMt
y
C t/v
srrEADDREss_,23_Q_Z=_L 40 Q 47
-Q0 2 DATE INSPECTED
PERmrr #10—i— _�_ADB#
DESCRIPTION OF WORK TO BE INSPECTED M�,ID
oved p. ans. FInal'approval
A. field Inspection was conducted to determine final compliance with appr
no objections from the above signed Department to the release of
denotis that there are
PkMRMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION -,OUTSTANDING ISSUES
Q Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date____� Si
ocaprvi.doc.l:temp:bldg:formsIO/OI
z
9
0
M
=i =5
M
C
M
0
80
C
--I C
3: M
M z
04
C
3:
0 -n
n
4
3:
M M
a
0
0
C
M 0
Z
.1�
X
z
ca
z
9
0
M
I
two. �sf�"C-Jfo"'
4 1
MAP,
It I
L
4 RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......Owosso of@ 004 &*a
0.
FOUNDATION.
rd
Footing
1
r.wall
Pier/Porch
%
I I
Retaining Wall
Slab Insulation
1 r I .
n .
PLUMBING. (A
a
z s I I I - L, 1. 0, 1 L
Unde 'round
1`9
Lf It L', 0 1, 1
M
k awl
Rougholn
I d
ICommerclal Final
HEATING 10
'd 1,
c %
I P L z
Gas,Test
Gas Piping
I P
Equipment
I f
I t I I toots
t Commercial Finial I I
EXTERIOR SHEATHING.
rn
NAILING Goes$*#* U
G r.
FRAMIN
I Pr
I;
:r, FIRST FLO
I P, OR FRAMING*,
t so
T.1
Wr
I r I I , I L .
INSULATION
I k I r I P
Floor Insulation 'L 11
f I I
Wall Insulation
t -!,I
L d
(A�
Coiling Insulation *toots*
4
SHEETROCK NAILING see 0
M
SPECIAL INSPECTION *00
1 4 0 1 L I I I
P I 14 1 1 1 P
MISCELLANEOUS 600008069$ t
FOR
FINAL APPROVAL
I I
1 4 1 OCCUPANCY
904
I P
6
I
DATE RECEIVED
h
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
r L,^vtnTjr I,, Rr",,TA( 12 ANT
MAILING ADDRESS
23p2r5i I
CITY
2jow)5
NAME
ADDRESS
CITY
NAME
I
KLI
ADDRESS
I.Ifv"
ZIP I TELEPHONE
ZIP I TELEPHONE
CITY ZIP TELEPHONE
STATE LICENSE NUMBER
E)
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
0 RESIDENTIAL
0 A . ODITION
COMMERCIAL
0 REMODEL
0 APARTMENT
0 REPAIR
0 GRADING CYDS
0 DEMOLISH
0 TANK
o GARAGE.
0 RE.TAININGWALL
z
CARPORT
R CKERY
I--
(TCE OF USE, BUSINESS OR ACT I
[3 34FNEVFM I
NUMBER
NUMBER OF
OF:
DWELLING
co
a
o
STORIE S
UNI
DESCRI13E WORK TO BE DONE
U_ U
r
HEAT SOURCE G,LAZING %
I —
0
PLUMBING / MECH
El
COMPLIANCE OR
CHANGE OF USE
0
SIGN
FENCE
( — X
RENEWAL
PERMIT EXPIRES
USE PERMIT
ZONE ja NUMBER"J,�V,?,�/
JOB SUITE/APT#
2=5 1=1 AVF_ ki =0
5, 1A dF
PLAT NAM E/SUBDIVI SION NO.
LOT NO.
L16 NO.
LID FEE $
TESCF Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Par"'It Required 0
Street Use Permit Req'd C)
EXISTING - PROPOSED
Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION- FT
Underground
Wiring required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
cc
uj
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
W
ENGINEERING
REVIEWED/DATE
FIRE REVI BY DATE
F I E R E V I
Z' I
/-02,
0
C
VARIANCE OR CU
V A '!A
SHORELINE OR ADS#
INSPECTION
BOND
REO'D
POSTED
m ;.7
E3 YES (:) NO
SEPA REVIEW
E AF
P
SIGN AREA
HEIGHT
.
COMPLETE EXEMPT
rEXPT
ALLOWED PROPOSED
PROPOS
ALLOWED ED
m
OT COVERAGE
T
L Lo Co,
REOUIfIJED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
REAR
C
LLOWED PROPOSED
A LLOW
FRONT, SIDE REAR
FRONT UR SIDE
m
z
—
I
0 C
. ,
PARKII
P R ING
LOT AREA
PLANNING REVIEW, ED BY DA7
REO'D PROVIDED
FT) A S
CHECKED BY
C OCCUPA
1.
4a OL-1#7
]7PED*OVTRUCTION
GROUP
CRITICAL
AREAS
SPECIAL INS�PECTOR JAREA
CUPA
NUMBER
QUIR
REQUIRED [3 YES j
�VA
tREMARKS
>
M S
R
P P 0 S, INAL INSPECTION
ROGRES'S INSPECTIONS PER UBC 108fF
m
m
C
z
0
rv.
IT! M,
0
0 Fnl
C
1E0'
0
W1 MUM OEM I
VV1111 Was
L
z
VALUATION FEE
PLAN CHECK FEE z
LOT SLOPE % ZA WOW
BUILDING
IT!
VESTED DATE PLUMBING
PLAN CHECK NO:
0_5
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
FIC RGE
PERMIT APPLICATION: 1800 AYS�
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS VL FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION so—
W,Nr_SVE461ON FEE
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
j
;N INTEREST. AGREES TO INDEMNIFY� DEFEND AND HOLD HARMLESS THE Cl I y ul- LANDSCAPING
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY - RECEIPT
PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
90
FROM THE ISSUANCE OF THIS
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' RECEIPT
TOTAL AMOUNT DUE
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Otfiftl or his/her Deputy: and Foos are paid. and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
IN VIOLATION OF THE LABO,%.GQDE
WORKMEN'S COMPENSAOINSQPANCE AND,RCW 18.27. 0 T 'IE DATE
]:DAT�ESIGNED
SIGNATURE (OW R Oij Al,�E T)
771-0220 '�ELE By DATE
VNTION EXT 13133
ATT
SE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IT IS LTO U 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD -ASSESSOR
5198
__j
X/