20030096.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
CHARLP-S D. KAt_KWAFr-
MAILING ADDRESS
Ave. We_,-zs-T
CITY TELEPHONE
Eomo_o n'_5z'Pq?140 49-i TAS Z38
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBL#
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DAT
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PROPERTY TAX ACCOUNT PARCEL NO.
0
NEW RESIDENTIAL qa�IM�SIN IMECH
A CEOR
N
ADDITION COMMERCIAL 0 CHANGE OF USE
MULTIFAMILY SIGN
REMODEL 1:1
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FENCE
GRADING
SPEW CYDS 1:1 x— Fr)
DEMOLISH OTHER
TANK
GARAGE o RETAMINGWALL FIRE SPRINKLER
cARPoFrr ROCKERY FIRE ALARM
(ME OF USE. BUSINESS R ACTIVITV LAIN:
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NUMBER NUMBER OF CRITICAL
'3 OF 14 WELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORCIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr ISSUANCE OF THIS PERMIT SHALL NOT BE
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.*
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 CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S C�NSATION INSURANCE AND RCW 18.27.
ftSIG - E �VNER R AGE" I DATE SIGNED
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,q �S I PERMIT EXPIRES
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USE PERMIT
ZONE NUMBER
JOB SUITEIAPT#
ADDRESS
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TF50F Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permh 116quked
Street Use Paffnft Reced
EXISTING — PROPOSED InsWt1on Requited
SIdswalk Required
Underground
REQUIRED DEDICATION- FT Wiringrequired
METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
0 C3
YES[3 N
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
GAS FIPE TEST MUST BE
OBSERVED BY CITY INSPECTOR
ENGINEERING REVIEWED BY Klim Aj:I"l�jJjPjj DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADS# I INSPECTION BOND
REO'D 01 POSTED
113YEs 13N $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING DATE
REO'D I PROVIDE L"tMMIERVICE S11=FF
,jl��AITER
JU 12 1 ^OR"M A III T% r%1kT vemrrr"
REMARKS SH 11 ___ - ___ -1
LM AS IT 19ITIM THE BLULDING
CHECKED BY jTYPPfjt0ffQjrION _I r0n& OCCUPANT
PECLAL INSPECTION JAREA rz GROUP -0
OCCUPA
REQUIRED [:] YES LOAD
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Description
FEE
Description
FEE
klan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This applIcaltion Is not a permit until signed by the
Building Official or his/her Deputy! and Foos are paid, and
- recelptisacknowtodgod In space provided.
OrFAC LS S> ;RE DATE
7��_WJ3
RtL-EAdEb -BY
ATTENTION U MA I 1;j;jj
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 YELLOW - 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
5
FIN
MEMO TO: PERMIT COORDINA
FROM:
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KrAMSM
PLUSESIaN
k"A
BUILDING DIVISION
rROVI
TO:
DATE:
DEPARTMENT DATE-
NEERING DIVISION DATE,__Qt*_0_a__.
DIVISION DATI�_
SITE ADDRESS- qMk AR A
PERMIT # 009 to ADW DATRINSPECTED_a-�03
DESCRIPTION OF WORK TO BE INSPECTED L-tYW'
-approved plans. Final approval
A field inspection was conducted to determine final compliance with
denotes :that there are no objections from the above signed Department to'the'release.,of
PERFO.RMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WIT11 CONDITIONS NOTED
a Copy of CONDI[TIONS given to ownex/contractor by inspector
FAILED FINAL INSPECTION - OUTSM kNDING ISSUES
ci Copy of CORRECTION NOTICE g ven to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si n
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
''SETBACKS . ......
FOUNDATION.,
.................
Wall ..........................
Pier/Porch ...............
Retaining We ........
Slab Insulation ..........
PLUMBING:
Underground .............
'X. -d
Rough -In ....................
Commercial Final .....
Gad T6st ...... ......
Gas* Piping ................
Equjpment ........
%CcimmerclafFirial .......
EXTERIOR SHEAT'11NG
NAILING . ............. ..........
FRAMING .............. ............
FIRST'FLOOR FRAMING...
4r
DATE RECEI Eo
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRES�A 4't dkz
a
OWNER NAMEINAME OF BUSINESS
C14ARL-f-S t�- KAL-KWA95
:L
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
15 MAILING ADDRESS
LID FEE S
ZS104 cig-'rik Ave. WEs-V
TESCP Ap%r
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Per. . .
CITY
1� ELEPHONE
E.0mewo-5z"'Valo *778 zzas
Street Use Permit Roq'd
EXISTING — PROPOSED Impaction Required
Sidewalk Required
REQUIRED DEDICATION— Fr Underground
4!2!3
Wiring required 13
'r.
NAME
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
YES 13 NO C3
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ONE
US NPE TEST [AUST BE lift
NAME LO
00-M—aft"t-bil IT Ina tuff-
Row-C.- 7
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ENGINEERING REVIE911FINW01111T lug 13 - - LON DATE
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ADDRESS
ACCEPTED
I
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE_
Ix
— -
STATE LICENSE NUMBER EXPIRATION E isy
VARIANCE OR CU SHORELINE OR AD1111 I INSPECTION BOND
REO'D POSTED
OyEs 13NOIS
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPL E EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
00 40,�)-100 1 % C?(n
, , ,
EXP
77
NEW RESIDENTIA L PLUMBIN MECH
LOT'COViRfidE! REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
ANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULnF'AM1,t, SIGN
L
PARKING LOT AREA PLANNING REVIEWED BY DATE
PROVIDED
GRADING 4 CYDS FENCE X
avow ( _ _Fn
IMMMULT MD I - IBC 605
REMARKS A WATER SERVICE SHMIPF
[:) DEMOLISH TANK OTHER
SKMI BE RMAIJIM OR TIM
0 GARAGE RETAININGWALL FIRE SPRINKLER
FIRE ALARM
f - Ws *9 M—"WM"."AE—S RUMBIM
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
rc
CHECKED BY I TYPE OF 991-1%11 I C11 If
T—CRITICAL
in n ff
0
NUMBER NUMBER OF
OF DWELLING A EAS
'4
SPECIAL INSPECTION
VVIVIr LV�
HT
STORIES UNITS NRUMBER
IA6=16
RE,U,,ED,,YES
DESCRIBE WORK TO BE DONE Re E*X1E;"t*tWn OK%
I
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE(YD
SeOiLde- Wiise r-g.. me-rer-'t C) �Aao-':w-4
PURSUANT M ECDr- I "
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*PREffiGMR=J1-A6MRyA1VH0X
SHALL BE INSTALLED NEAR
GA LIJ I- 10 bS 611—. A !'A oep 6 v,. Awn Wrr,-e a.
VALUATION THE VVA-TER SHUMIFF
kA.Mmellm to CIA'AA&S WAS%Se.
6X-rF-VzD &AS -St9-VIlie�11h �RtAN 1�ugWAO-C, —to
Description
FEE
Description
FEE
FPu- '. Lo w I- r� r t iz tr-- P1, A el it-S. M 6 A IPP L I A
Ian Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
,PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMrr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBILIC
2
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: ISO DAYS
PERMrr LIMIT: I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
Engr. Inspection
SEC BACK OF PINK PERMIT FOR MORE INFORMATION
'4PPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
14DMONDS,
4 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 CITfS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
-i.
f
Recoraing Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
HERE"
APPLICATION APPROVAL
GIVEN IS CORRECT6 AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
GIVEN
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
OW
This application is noLa permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
BuildIngLOMcIaLor histher Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION rewipt Is acknowledged Inspace provided.
LEI
WORKMEfCS CPEJNSATION INSURANCE AND RCW 18.27.
0 1 LS 81 RE D
a G E jbWNE9 �R AGENT) DATE SIGNED
I
LNT
2 cc) Z3
771-0220 -RWLEASED
BY
ATTENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS 13EEN MADE ANU APPKUVAL UK A L;t:K 111-1- OR GINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P�NK-OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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