20030087.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP I TELEPHONE
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NAME
ADDRESS
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CITY
NAME
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ADDRESS
CITY
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ZIP TELEPHONE
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ZIP
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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)9� NEW [3 RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
TELEPHONE
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EXPIRATION DATE I CNECKI
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0 REPAIR
CYDS
13 DEMOLISH
TANK
oGARAGE
RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVIll EXPLAIN:
010 /_17 1i B&S
NUMBER
OF
NUMBER OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
I
IN
HEAT SOURCE
aotrls
9—CHECK I
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
EiFENCE
( X FT)
077ER
F RE SPRINKLER
FIRE ALARM
[PERMIT EXPIRES
USE PERMIT
ZONE
C�05-"1,7
NUMBER
JOB SUIT[l
ADDRESS
Ila 4,1,g -5
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP App"r4td
RW Permit Required
EXISTING — 611 PROPO D !0
Street Use Permit Roq'd
Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
underground
Wiring required SK
LINE fjZE
NO. OF FIXTURES
PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FIRE REVIEWED BY DATE ul
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VARIANCE OR CU
SHORELINE OR ADB*
INSPECTION
BOND
A.013_01_1�1
13 Fill
I YES �K
POSTED
1$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLET EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
LOT COVERAGE
REQUIRED SETBACKS (Ii
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
PARKING
CyD I PROVIDED I
LOT AREA
PLANNING REVIEWED ay DATE
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JAREAS SPECUILINSPECTION JAREA OCCUPANT
NUN 110YES LOAD
111REMARKS I -
III PROGRESS INSPECTIONS PER USC I 08/FINAL INSPECTION REO'D
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$
Description FEE Description FEE
% LOT SLOPE % Plan Check State Surcharge
--,Z� Building Permit City Surcharge
VESTED DATE Plumbing j6l
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Mechanical
THIS PERMIT AUTHORUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURISS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
t:
Ell Review
5 PERMIT APPLICATION: 150 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARIll WITHIN 180 DAYS
Ell Inspection
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUrCESORS
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
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
11
Recording Fee
L_
Receipt #
I HEREBY ACKNOWLEDGE THA HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THA AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. kAGRE TO C WITH CRY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a porMll until signed by the
TION; ING HE W AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VI 8 ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt 13 acknowledged In space provided.
WOR E RANCE AND RCW 18.27.
0 11 GN DATE
S:= 1� � k I I k! ill ill
DATE SIGNED
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771-0220
RE D BY DATE
ATT ION
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 - I'll E YEI I ON - fNSPeCT0R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
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GREEN - ACCOUNTING
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wall........................
Pier/Porch .................
Retaining Wall ...........
Sa n 6 n .......
PLUMBING:
round .............
Rough -In .................... .
Conimerclal Final ......
HEATING:
....................
f
GasPiping .................
E ulpment,
q ..................
Commercial Final
E)ffERIOR SHEATHING
NAILING ..........................
FRAMING ........... ...........
. .....
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation ........
SHEETRock NAILING ...
�.SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
. I—DA—TERECEMD
PERMIT EKPIRES
'5' E t =2 1
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS
F,*T,40 a/
PLAT NAMEISUBDIVISION NO. LID NO.
LID FEE $
TESCP Approww
PUBLIC RIGHT OF WAY PER OFFICIAL STRE fi� MAP my permit R"ked
street Use Permit Reqd
EXISTING Inspectitm Fisquired
ked
Sidewulk Required
Undergrowid
MAILING ADDRESS
Z P
CITY I
TELEPHONE
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REQUIRED DEDICATION,�Fr Wiring required
4 LINE JVZE NO. OF FIXTURES PRV REQUIRED
STI 02-� YES [3 NO 13
NAME
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_hEMiAKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
DDRIIISS
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CITY ZIP
FTELEPHONE
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NAME
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DATE U1
IEWED BY or z
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CITY ZIP
TELEPHONE
VARIANCE OR CLI SHORELINE OR ADB# INSPECTION BOND
REQ'De POSTED M
01_1�1 113YES W_O 1$
STATE LICENSE NUMBER EXPIRATION DATE
Y
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SEPA REVIEW SIGN AREA HEIGHT
COMPLET EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
Vi �
PROPERTY TAX ACICOUNT PARCELO,
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NEW RESIDENTIAL PLUMBING MECH
VERAGE REQUIRED SETBACKS (Fr.) PROPOSED SET13ACKS (FF.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR M
C)
COMPLIANCE OR
ADDITION COMMERCIAL 13 CHANGE OF USE
9
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PLANNING REVI D BY DATE r. , .. .
PARKING LOT AREA IL M
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PROVIDED
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REMODEL 0 MULTIFAMILY SIGN
OD M
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FENCE
REPAIR X CYDS, 0 X FT)
1 , %; 1, 11 . 10
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REM, S P Z
OTHER
0 DEMOLISH TANK
oGARAGE [3 RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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OR ACTIVITY) EXPLAIN:
M?E OF USE, BUSINESS
In
41,4-9—r
BY NSTRU N CODE OCCUPANT
CHE D GROUP : I ;
1119 M M
OCCUPANT
SPECIAL INSPECTION AREA a
LOAD
0
CRI1111CAL
NUMBER NUMBER OF AR AS
OF DWELLING EA
'5 1 1
. 1
STORIES
REQUIRE ES
Y 0
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPEcTi6Ns PER UBC 108/FINAL INSPECTION REaD
C_ At'i
es'lic kcrf
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L4 4��
UAnON
$
Description FEE Description FEE
Plan Check State Surcharge z
vo
33
HEAT SOURCE
a
WW
LOT SLOPE %
"
Building Permit '1110 city Surcharge 0
M
Plumbing
VESTE
PUR CHECKMQ: D DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
9
Engr. Review
15 PERMITAPPLICATION: 1800AYS,
PERMIT ILIMM I YEAR - PROVIDW WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
I � LIAMAI ESS THE CI OF
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HU
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEEb, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
6Z
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
OF THIS PERMIT SHALL NOT BE
-
Amt. Due
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total
LA
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
L115 7ay__1
I HEREBY ACKNOWLEDGE 1A IS APPL16ATION; 'THAT THE INFORMATION
THA READ TH
1A OQ THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROVAL
MY9
GIVEN ISS CORRECT, AND THA� I THE OWNER.
THE OWNER. AAGRE9 TO I.Y WITH dITY AND STATELAWS REGULATING CONSTRUC-
WILL BE EMPLOYED
CALL
This applicaUon Is no a permit until.signed,by the
Building Omcw or his/her Deputf. and Foes are paid, and
'no I ING IrHEI AUTHORIZED THqRABY, NO PERSON
ODE OF tHE STATO OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is arknovirledged In space provided.
IN I dE Lte
WORI RANCEIAND RCW 18.27.
OF�!C _GNA DATE
I
111-111—HIA11 a
BIG n t:
DATE SIGNED
IAO
V125)
7n X C �
771-0220
S D BY DATE
ATTLVTIO'N
Off 121133
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YE LLOW - (NSPECTOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES