20030104.pdfM
DATE RECEIVED
PERMITEXPIRIES
u1st: PERMIT 2X,3 lCq
ZONE
CITY OF EDMONDS
NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER �AMEINAMIE OF BUSINESS
M L4_6Q.
LAT NAME/SUBDIVISION NO. LOT NO. LID NO.
I
LID FEE $
MAILING ADDRESS
2 pve We!&+
T) 1 -7, C�'S
_TESCPAPr*0V6d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permit Requited
Street Use Permit RK-1
CITY TELEPHONE
ZIP
inspectio Requk ad
EXISTING — PROPOSED Sidewatik"Required
I -
Underg-und
REQUIRED DEDICATION— FT — wirina required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NAME
YESE3 NO C3
I
ADDRESS
REMARKS NTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE: z
OWNER/CO
CITY ZIP ONE
NAME CBLN
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167 51 &3OS-105 I'
GINEERING REViEWED BY DATE
ADDARISS
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FIRE REVIEWED BY DATE
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OND
VARIANCE OR CU SHORELINE OR ADS# INSPECTION BI
POSTED
STATE LICENSE NUMBER EXP U qWVQ_*,LD BY
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REO'D
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SEPA REVIEW HEIGW__
%WXMWAL ALLOWED ROPOSED
'BE
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EWI
P WENT FQF3
9
EXP
1:1 NEW j2rRESIDENTIAL 0 PLUMBING MECH
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ALLOWED PROPOSED FRON"TS DE REAR
COMPLIANCE OR
ADDITION COMMERCIAL 0 CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN
ROVIDED
E:] FENCE
0 GRADING X FT)
REPAIR CYDS
REMARKS
OTHER
DEMOLISH
P�TANK 0
GARAGE RETAININGWALL 0 FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINE��l An!
CHECKED By T ON OCCUPANT
:EXPLAIN:
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NUMBER NUMBER OF CRITIC
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SPECIAL INSPECTION EA OCCUPANT
LOAD
OF
STORIES UNITS NUMBE AA_
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DESCRIBE WOft TO 13E DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108XINALINSPECIIIIIJIN My !3
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VALUATION
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Description
FEE
Descri ption
FEE
I
Plan Check
rge
state Surcharge
—[—GLAZING % LOT SLOPE %
HEAT SOURCE
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
a DOMAIN (CURqS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: 160 DAYS
PERMIT UMrr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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, ASS IGNS AND SUCCESORS
IN INTEREgi AGREES TO INDEMNIFY. 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
Landscapelnsp. Total t. Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA NCE
a NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Receipt III
Recording Fee
I HERE13Y 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
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WiTi-I CITY AND STATE LAWS REGULATING CONSTRUC-
CALL Building Official or his/her Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
DE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged in space provided.
IN VIOLATION OF THE LABQ&,g
WORKMEN'S COMPEN NCE AND RCW 18.27.
OFFICIAL SIGINOTURE DATE
!2=
Ulf- DATE SIGNED
SIGNATURE (OWNER OR ENT)
(4200% 0110
LaiuL,
0 DATIEf
771-022 F(ELEASED BY
ATTENTION " U
EXT 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 - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
ARE MAKING 5 COPIES
04/02 PRESS HARD -YOU
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I YDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE E OF BUSINESS
L�_S n y
MAILING ADDRESS '-
-2-n -7, c�,s I-n A)-e u-),es+
CITY ZIP ITELEPHONE
NAME
ADDRESS
CITY
ZIP ITELEPHONE
PERMIT EXPIRES
dSE
ZONE
PERMIT
X3-o1Cq.
2
NUMBER
JOB
ADDRESS
SUITE/APT#
-7 CTZ��
PLAT NAME/SUBDIVISION NO.
T NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCF Appmved
Aw PefriA Required
Street Un Permit Wd
EXISTING —
PROPOSED
Impaction Required
Sidewalk Required
REQUIRED DEDICATION— FT
UnderWound
WkIng req 13
METER SIZE
LINE SIZE
NO. OF FIMRES
PRV REQUIRED
I
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
NAME CBL 0 tl(f
-3cl S(— 6 '1(— 3 0S —) 05
ENGINEERING REVIEWED BY
DATE
(
_,Ct*0 D fi) I yvi
CITY TELEPHONE
FIRE REVIEWED BY
DATE
IE
/-,q.kb,k Y-Y) U r_1
STATE LICENSE NUL40ER EXPI Cj=KFD BY
VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
REO'D POSTED
6—A _I6&f:L 21p7w 1 CED
13YEs ONO $
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA HEIGHT
ALLOVF WED, PROPO
M Ar
EXP ,
4RI�M
MUS-1
'AbP6SM'*TBACKS
[j NEW E] PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPO"
(FT)
LFRqM LeAll" REAR
�KFVXISsvil
ADDITION COMMERCIAL COMPLIANCE OR
1:3 CHANGE OF USE
0 REMODEL 1:1 MULTIFAMILY SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO`D I PROVIDED 916
REPAIR GRADING FENCE X
CYDS ( FT)
REMARKS
0 DEMOLISH ;J(TA�NK [:I OTHER
JET -W
o GARAGE R AINING ALL [j F RE SPRINKLER
CARPORT 0 ROCKERY FIRE ALARM
UWE OF USE. BUSINE�S
CHECKED BY TYPM
ON OCCUPANT
)e7LAIN:
P GROUP
R7
NUMBER NUMBER OF
0 CRITICAL,,�
OF DWELLINGU AREAS
-_
SPECIAL INSPECTION OCCUPANT
STORIES UNITS NUMBER
JAREA
REQUIRED 13YES
LOAD
DESCRIBE W09K TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REaO
(A VV\ uep
LA - ry.) o�r e
y I ri�
VALUAnON
1OL-A—) (_1 v6*de cc�
$
k
yr d
cjjf�e err
DeacriptIon
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLA23NG % LOT SLOPE %
Building Permit
01;0, City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMrT AITHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE Z PRIVATE PROPERN ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMrr APPLICATIOIN: 160 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK 18 STARTED 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
IN INTEREST, AGREES TO INDEMNIFY. 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
HE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due ibcl
DIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OR E
DEEM D MO DINANC
To
7 1 -A
NOR LIMIT IN AW WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HEREBY ACK14OWLEDGE 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 EMPLDYED
Building Officlai or hisiber Deputy: and Fees are paid, and
IN VIOLATION OF THE LA89A40DE OF THE STATE OF WASHINGTON RELATING TO
I
FOR INSPECTION facelpt 13 acknowledged In space provided.
WORKMENS COMPENSATI CE AND RCW 18.27.
OFFICIALY SIGIN�ATEURE DATE
SIGNATURE (OWNER OR DATE SIGNED
(41 22 5)
4.
7,
z , I i,.) �_M)
77%1-0220
0/r,
F(ELEASED BY DATEI
ATTENTION
EXT 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 -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