20030099.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME"E OF BUSINESS
SW66T PC
115 bAy ChM
MAILING ADDRESS
L4 O-A� -Skb AVE SOUT-P
CITY
ED /n ON 01.5
NAME
ADDRESS
CITY
ZIP TELEPHONE
ZIP ITELEPHONE
NAME
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0
CITY ZIP
STATE LICENSE NUMBER
0:11 PROPERTY TAX ACCOUNT PARCEL NO.
TELEPHONE
NEW
t&/RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
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RETAJNINGWALL
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CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR ACTFV" EXPLAJN:
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NUMBER7
NUM13ER bF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
CBL #
PERMIT EXPIRES
USE PERMIT
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NUMBER cz:,�W)s _e�o
JOB SUiTE1APT#
ADDRESS *3 :Z!5�04
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TEScP Approved
RW Parrm Required
Street use Peffnit Req'd
EXISTING —_--=�_—PROPOSED
inspection Required
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Sidewalk Required
REQUIRED DEDICATION FT
underiyound
Whing requited 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESM NO E3 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FIRE REVIEWED BY DATE ul
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BOND
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DATE
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By
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REQ'D
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PROPOSED SETBACKS (Fr.)
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ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
UR SIDE REAR
2
COMPLIANCE OR
IFT)REMARKS
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115
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CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
SIGN
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FIRE SPRINKLER
FIRE ALARM
CHECKED BY I TYPE 0,f:.-:9O1A&TRU TIO C -.4 N1 /
CRITICAL <.— In Ut f R ' /,67.3
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER RE LOAD / 2
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PROGRESS INSPECTIONS PER UBC ICS/FINAL INSPECTION REG' Ell
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VALUATION
$
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Description
FEE
-
Doscription
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED
Plumbing
Se— 2A
-DATE
Mechanical
THIS PERMIT AUTHORIZES ONILV THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLV. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
Engr. Inspection
SEE 13ACK 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 INDEMN117X DEFEND AND HOLD HARMLESS THE CITY OF
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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt # [L 95^
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 CONSTRLIC-
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/hef 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 provided.
WORKMEN'S COMPENSAT��ffE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
S9QhVffLlRRE (OWNERWV DATE
(425)
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IT IS LNN4bkWFU TO OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINZ FILE YELL4. 4S94CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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PERMI T EXPIRES / f -moommi
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT# IF
CONSTRUCTION PERMIT APPLICATION ADDRESS
L103 3)"0/
OWNER NAME/NAME OF BUSINESS &Z '<1
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
:SW6C-T PeAS bflly CAM
MAILING ADDRESS LID FEE
TESCP AppnNW
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pam* RequIred
H03 -SRb AVE So07—P a',,
street Permh Req'd
CITY ZIP TELEPHONE EXISTING PROPOSED k1spection Required
SidmalkRequired
,-- FT
REQUIRED DEDICATION— Urulerground
ED M oN 6.5 q8020 4z3*_'7_?1_301(0 1 WMQ roquirea [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO 13
ADDRESS REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ONE
NAME
I?- ENGINEERING REVIEWED BY DITE
ADDRESS LO
TV—k D I
FIRE REVIEWED BY DATE
CITY ZIP ELEPHONE
IT
—M 4A
M
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VARIANCEORC51 SHORELINEORADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHEC RE POSTED
oik;
MYER $
I
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TM ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED . PROPOSED
--7--7 co I
wor 400 If
, ,
EXP
NEW tVRESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
REAR
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE
COMPLIANCE OR
ADDITION COMMERCIAL 0A Its 1,40. w is -43.5
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
13 REMODEL muLnFAmitY SIGN REOD PROVIDED
I WA Lz-1 d)3-
GRADING FENCE X
REPAIR ri CYOS FT) REMARKS
DEMOLIS14 TANK OTHER
[3 GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(rYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
CHECKED BY TYPE ICODE OCCUPANT
IVIARE )
=U9TI0,h
-1 �j — /%, I GROUP
.NUMBER NUMBER OF TCRITICAL
OF DWELLING! AREAS SPECIAL INSPECTION JAREA OCCUPANT
w
LOAD
U IT NUMBER
NITS REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FiNAL INSPECTION REC?D
WSTALL, KEE STAMb 1AJ 6 :S I GPJ
1 L;T
VALUAnON
Description FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
C y S u rcha
PLAN CHECK NO: VESTED 13ATE Plumbing
/" :Q��
Mechanical
THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: W DONE ON PRIVATE PROPERITY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
VA
DOLWN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) LL REQUIRE
SEPARATEEPERUISSION.
Engr. Review
PERMIT APPLICATION: 1e0DAYS
fRecelpt
06 PERMIT UMrP I YEAR - PROVIDED WORK IS STAMD 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 11;31 __40
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, IT$ OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND ce pt #
Fire Inspection # 4:9/1 tp
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMff. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapainsp. Total Amt., Rye. 91.
91 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- T' . '. 1. . ,
zvw
pt
Recording Fee R celpt#". Zz
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN 18 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
114 VIOLATION OF THE LABO&PODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPEN!:29�9%HqCE AND RCW 18.27.
OFF%IALS Slqt,�TURE DATE
DATE SIZED IA63
1,425)
BMULWE (OWNEWV
1 02 1-0220 &jam)
0
77
PR 6DRY
A 0 Off 1333
7VW%T/O
IT USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELL INSI(ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
04/0� PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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