20030093.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
Ey NAMEINAME OF BUSINESS
ING ADDRESS
-�k'7
ZIP ITELEPHONE
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
j
6t rn ('_�
Oaal
CBL 0
I
ADDRESS
Crj
TELEPHONE
)A
ACCOUNT PARCEL NO.
PERMIT EXPIRES
USE PERMIT
ZONE q NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TIESCP AP 'ZV
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerMt1PR 11.
Street Use Peffnh Roq'd
EXISTING PROPOSED inspem" Required
Sld&wAlkR@qulfod
U
Z
J
0
S
B
E
N
JJAOD
PL
PU
EX
REQUIRED DEDICATION- FT Undergmund
Wiring required cl
M ETER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
YES 13 NO E3 z
RE MARKS
0 V�
WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
A4A � _ , _ . / - I - d - Al .. 1,
REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADB# INSPECTION I BOND
REO'D POSTED
SEPA REVIEW 'IGN AREA I 13YEs ONO $ PEIGHT
III
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED
0 NEW 0 RESIDENTIAL
PLUMBING / MECH
LOT COVERAGE REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
LJR SIDE REAR
ALLOWED PROPOSED FRONT SIDE REAR
I I
FRONT a
ADDITION
COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
Le
z
DATE
REMODEL
MULTIFAMILY
SIGN
PARKING LOT AREA PLANNING REVIEWED
REOD I PROVIDED
BY
REPAIR
GRADING
FENCE
CYDS
X FT)
REMARKS
0 DEMOLISH
11 TANK
OTHER
GARAGE
-1 RETAININGWALL
1:1
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
PE OF USE, BUSINESS GR ACTIVITY) EXPLAIN:
CHECKED By TYPE N CODE
OCCUPANT
orn
_QLC
�JRUCTION
GROUP
NUMBER
NUMBER OF
CRITICAL
OF -eZ,
DWELLING
I
AREAS
�11A
SPECIAL INSPECTION AREA
OCCUPANT
LOAD
STORIES
UNITS
NUMBER
Ij YE
DESCRIBE WORK TO BE
DONE
REMARKS
A-
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REO'D q
$ I
Description FEE Description FEE
Plan Check I State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
a
3 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: IGO DAYS
06 PERMIT UMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAK 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 III
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, 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
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
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
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 Fees are paid, and
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space providad.
WORKMEN!S COMPENSATION INSURANCE AND RCW 18.27.
OF ICI SIGN! �/613[TE
�E
SIGNAT (OWNER OR G
DATE SIGNED
25
-;?17
771-0220
T
RELWED BY E
ATTENfM'(/
E" 1333
4a
V AA
*7
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IfIz
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPICTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
z
0
4
0
M
M
C
M
40
0 C
� C
M
M
z
0 _n
M M
a V;
0
0 Fn
C
MO
z
CO),
z
0
5
M
"J
a
ol ON, 0
I
DATE
DATE RECEIVED
171
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
EF NAMEMAME OF BUSINESS ----%
MAILING ADDRESS
ZIP
NAME
ADDRESS
Ki
W
CITY ZIP TELEPHONE
NAME� 7CBL #
ADDRESS
I Olt) 6 0y,
Cola . I I A".
SER� . !--
LICENSE.NUW
PROPE7Y7 ACCOUNT PARCEL NO.
TELEPHONE
lw_l-- el?sl- 01.9y,
0 NEW
0 RESIDENTIAL
ADDmON
f4Gff COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADIN . G CYDS
0 DEMOLISH
TANK
GARAGE
CARPORT
RETAININGWALL
ROCKERY
UWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
PLUMBING.1 MECH
IMPLIAN � E OR
,CO C
C4NGE OF USE
SIGN
FENCE
( _x FT)
OTHER
0 FIRE SPRINKLER
FIRE ALARM
`4*N4RES
PE6Z
USE PERMI
ZONE e
q NUMBER c�2 -eW,_fff
Mi
�fo.
JOB SUITE1APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP
RW PermitIRr=,
at 11-9 Permit Reqd
EXISTING — PROPOSED
inspacWn Required
Sidewatic Required
REQUIRED DEDICATION— FT
lu 13
METER SIZE
LINE S ZE
NO. OF
PRV REQUIRED
I
YES C3 NO 13
z
REMARKS
z
F
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
11
.AA - - I - I - I . A - I A. I- — _. -
FIRE REVIEWED BY
DATE
DATE us
cc
M
VARIANCE 081 CU SHORELINEORADB# INSPE 'ON BOND
RE07D POSTED
OYES ONO Is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ`D I PROVIDED I
REMARKS SAAM11111111111IM1111 =M=Mk
IL
jejftjdj-±j. c_r—
"ON c
CHECKED CONS RUCTION AN 1.8
PE GRO
GROUP
R) I
NUMBER NUMBER OF CRITICAL
I �OF DWELLING AREAS
SPECIAL PEE ION AREA' OCCUPANT
STORIES UNITS NUMBER
REC S
DESCRIBE WORK TO BE DONE
REMARKS
UBC S ION REjQW'D`
PROGRESS INSPECTIONS PER UBC 1018)/FINAL INSPECT
JWIS;17+1� 7M
4W) R&, IM23C
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DOME ON PRIVATE PnOPEMTV ONLY. ANY CONSTIRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
21
15 PERUITAPPUCATIfN0S0*_V8
1 at
f
'EAgry
PERMIT LIMM 1 YEAR - PROVIDED WORK 15 STMMD&HIN 180 DAYS
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 IN AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
MJNREST,
ED DS, 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 11119 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
Landscapeinsp.
Total Amt. Due
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
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
)N
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 Officlall or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space plovided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
OfFIC SI D�TE
IA4#
SIGNATY0 DATE SIGNED
(OWNER OR C
(4,251
1 0�
.1 -- ;?17
I
7A
'1 11
.
-1
-0220
REL ED BY 0 E
ATTENif0W
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
1,4A.111
R
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YEILOW-INSPICTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
z
0
4
0
M
Q M
M
C
M
z
0 _n
M M
0
0 Fn
C cl)
C Q)
0
z
-24,
0
M