20030100.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP 0 ITELEPHONE
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NAME 10i0t67TOA) IR94 hkred
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ADDRESS
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CITY �Z'P ITELEPHONE
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NAME ICBL#
LICENSE NUMBER . . I EXPIRAT1014 DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL.NO.
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0 1,5'-960 1P o77A9,'?300/04cQ 00
NEW 13 RESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS I _ X_FT)
DEMOLISH TANK OTHER
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY]I EXPLAIN:
PUB L4 C, R6C901-776 A
NUMBER NUMBER OF CRITICAL
OF DWELUNG AREAS
U 40
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STORIES N Me
DESCRIBE WORI(TO BE DONE
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[PERMITEXPIRES ��IjiP
USE PERMIT
ZONE NUMBER c5�eeO-7? - 0 lee
JOB 'To
ADDRESS
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PLAT NAME;SUBDIVISION NO. LOT NO. LID NO.
LID FEE
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW PefwA Required
Street Use Peffnh Rsqd
EXISTING — PROPOSED Inspection Required
Sld&wa* Required
Underground
REQUIRED DEDICATION FT wiring required 13
METER SIZE LINE SIZE I NO. OF FIXTURES PAV REQUIRED
I YES13 NO E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
FIRE Rp"
�W'D BY
DATE lu
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1--2-o-02
VARIANCE OR CU
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INSPEcTioN
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POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED,
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LOT COVERAGE
REQUIRED SETBACKS (FT.).
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT QRSIDE REAR
IVA
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PARKING
BY DCJ
LOT AREA
PLANNING REVIEWED
REO'D PROVIDED
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REMARKS
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CHECKED BY TYP COILF,— 0
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIREDD(yE LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION IREQ�o
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Building Permit ity Surcharge
PLAN CHECKA% VESTED DATE Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) V61LL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
PERMIT LIMM 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 PERMIT. 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 CONSTRUC-
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 COMPENSATIONtAISURANCE AND RCW 18.27.
SIGNATUaR(OWNER 0 MGEWrf, DATE SIGNED
Lw IL lal / �/O 2-
ATTENTION
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
All��r
Recording Fee
Receipt #
WA) =
APPLICATION APPROVAL
CALL
This application Is not a permit until signed by the
Building official or his/her Deputy: and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged In space provided.
GN DATE
(425)
771-0220
—1 DATf
J�d.,
EXT 1333
RE ED BY
6,-11 /,
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 - INSPEAC
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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CITY OF EDMONDS NUMBER
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JOB 16 , '_� f<, - SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME/NAME OF BUSINESS
C14 (1 o L �Ch') LTY dj2 f9a""�- L PLAT NAMEISUBDIVISION NO. T16T NO. LID NO.
MAILING ADDRtSS LID FEE:C'-
TESCF Appr=d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerrW, R
f-700 )/)v1'/L Street Use Permh Req'd
'Stt.tet-
CITY EXISTING PROPOSED Inspectim Required
TELEPHONE Sidewalk Required
0,21 �3 0 REQUIRED DEDICATIONr--- Fr Und"W"""d
�WV (/'14 k J, Zj'Ptx o < Wring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
YES 0 NO 13 z
REID M,1'00�15_7_60 0X)L I)Pierei� I - —1 — I
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ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY 4?
�ZIP ITELEPHONE
lei �800
NAME CBL#
P/) Ls &2122�&Cm py ENGINEERING REVIEWED BY /DATE
DDRESS
FIRE REYlh)NED Y DATE
CITY TELEPHONE
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cc
—1-0 -0
VARIANCE OR CU iORELl
11 01 ADBN INSPECTION BOND
EXPIRATION DATE CHECKED BY .. POSTED
STATE LICENSE NUMBER ISR�Q EQ'D
OZ- -40 37 ISKSI 13NO
- 02.
406-o
ii�2 SEPA REVIEW SIGN AREA HEIGHT
PROPOSE PROPOSED,
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED D ALLOWED
o 15260'e Q7L") 3.�3010416200 PON$ NA IVA ,
L1.
4*7 EXO) OIL VL_
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR
0 ADDITION COMMERCIAL CHANGE OF USE IVA "A aA
PARKING LOT AREA PLANNING REVIEWED BY
REMODEL 1:1 MUL11FAMILY SIGN REOD PROVIDED
I RA evoi.
GRADING o FENCE X
REPAIR 11 CYDS ( - -FT) REMARKS
f
o OTHER
DEMOLISH 0 TANK
[3 GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
Cr . YPE OF USE, BUSINESS OR AC7IVrM EXPLAIN: , CHECKED BY TYXPOF CONSTRUCTION E OCCUPANT
Icon
POL/c,
I RaPCAIPO�_) A . I GROUP
!Z7
NUMBER NUMBER OF CRITICAL j
OF A EAS SPECIAL INSPECTION JAAEA OCCUPANT
DWELLING R LOAD
STORIES UNITS NUMBM4AP4 REQUIRED;JYES
DESCRIBE WOR9 TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER LIBC 108/11FINAL INSPECTION REQ'D
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FEE
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FEE
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State Surcharge
HFATJSGUI(CE GLAZING % LOT SLOPE %111,14P
qp Building Permit City Surcharge
K?O- VESTED DATE Plumbing
Mechanical MUM r
THIS PERMIT AUTHORMS OHLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading LE: I
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) YfiLL REQUIRE
Z -
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATIOW. iso DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMIAMON
11 'APPILICANITj ON BEHALFr OF 1*8 OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS, Fire Revievy PlanChk.Deposk
!9 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITSOFFICtALS, EMPLOYEES, AND AGENTS FROM ANYAND Fire Inspection Rece pt
ALL CLAIMS FOR DAMAGES OF WHATEVER HAVURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total t. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE )
2
NOR LIMIT IN ANY WAY THE CFfY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Receipt #
Recording Fee
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 Bulidlng Offtlal 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 provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27. In
OFF IR DATE
SIGNATURE (OWNER Of�#((GE DATE SIGNED (425)
-2—
0 771-0220 E Of-_ DATE-
j
ATTENTION hx I U J
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 - INSPECfOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
GREEN -ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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