20030120.pdfDATE RECEIVED
-4
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
marmaj Ewnloo
MAILING ADDRESS
g,;�50q q(,+,11
CITY TELEPHONE
2 �).C, 135
.LL)jcLd-% Q`P(Ad
NAME
&nnRFSR
CITY
ZIP ITELEPHONE
9 ;�
I
I PERMITEXPIRES
USE PERMIT
ZONE Lj��
N U M B E R
JOB
SUITEIAPT#
ADDRESS
a,
PLAT NAME/SUBDIVISION NO.'
LOT No.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I LsCP Approved
AW ParrrAd Required
Street i's PannhRoq*d
EXISTING — PROPOSED
inspection Required
S malk Required
REQUIRED DEDICATION— FT
u=
Wiring(aquirod
METER SIZE
LINE SIZTTNO.
OF FIXTURES
PRV REQUIRED
YESM NO C3 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
2
ADDRESS
Oil'
&--
CITY ZIP TELEPLJONE
vi,o (,ohcmi whw-t&9(gi I
STATE LIBtNVE NUMBER
I'm � -5
PROPERTY TAX ACCOUN
)I
NO.
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE ut
cc
rL
VARIANCE OR CU SHORELINE OR AOBN INSPECTION BOND
REO'D POSTED
113YEs 13NO 1$
BEIRA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED ALLOWED , PROPOSED
NEW
RESIDENTIAL 0 PLUMBING/MECH
LOT COVERAGE I REQUIRED SETBACKS (FT.). PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
I
0 ADDITION
COMMERCIAL COMPLIANCE OR
0 CHANGE OF USE
I
-DATE
PARKING LOT AREA
NING REVIEWED BY IL
[3 REMODEL
MULTIFAMILY SIGN
fLAN
REO`D PROVIDED
0 REPAIR
FENCE
GRADING CYDS X — Fn
REMARKS r"Iff
I A
IVIM11710HAt
DEMOLISH
TANK OTHER
f RE
ORESENT FE)R
oGARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY 0 FIRE ALARM
TANK F166,
EMOVA6, GR GAP
aYPE OF USE, BUSINESSM ACTIVTM EXPLAIN:
zllfe
CHECKED BY TYPE OF CONSTRUCTION
1
CODE OCCUPANT
1 GROUF
A/
NUMBER
OF
NUMBER OF
DWELLI
�UNITS
CRITICAL
AREAS
SPECIAL INSPECTION- JAREA
OCCUPANT
STORIES
NUMBER IV
REQUIRED YES
LOAD
DESCRIBE WORK TO
BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
/L/Y�
Q29
VALUATION
$
Doscription
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
city surcharge
57 —
VESTED DATE
Plumbing
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOLMN (CURBS, SIDEWALKS, DRIIVEWAYB, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160 DAYS
L PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLJCANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk, Deposit
IN INTEREii, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, rTS 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
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapainsp.
Total Amt. Due
NOR LIM17' IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
Building Official or histher Deputy: and Fees are paid, and
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
FOR INSPECTION
receipt Is acknowledged In apace provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0 Cl
T
S [a kT RE D T
URE (OWNER GE
DATE SIGNED
1A0
%425)
A I
Ir'l oo;14�0s,
k
L
771 -0220
E i Y
EL SElfl
TWENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
I
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
HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
04/02 PRESS
z
0
4
0
M
-4 :r,
M
M
0 C
M
40
0
A rn
0
0
Fn
C ca
ca
0
z
0
M
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM. FIRE DEPARTMENT DAT
z
0
m
=i 9
M
c
ma
0
80
c
--4 C
mm
m
z
r
cn
o -n
n
m m
a ro
0
0 Fn
C (j)
c (j)
M 0
Z
z
-4
X
V;
z
9
0
m
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign.
ocaprvl.doc.l:temp:bldg:formsIO/OI
13
DATE RECEIVED
1-j :4�/
PERIMIT EXPIRES
BE PERMIT
ZONE
CITY OF EDMONDS P�-� /<�r NUMBER
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
mar-iho-., EwoonS
MAILING ADDRESS
,�q;, 'a 5 () L
CITY d
III
TELEPHONE ID
NAME
ADDRESS-
A
C7.
.1 pp- TELgAHQNF, rvn
L--5
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO:
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP
RW Parm=ed
Strast Use Permit Ft"d
EXISTING - PROPOSED
Inspection Required
sidewalk Rowked
REQUIRED DEDICATION- FT
Undergrowd
WMq F.9--
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
1
I 1
YES 13 NO 13
z
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
11
NAMIff- 4 C4 01-�
-.--o(6yjR'0 " bauc,".", /1) '1 1v ENGINEERING REVIEWED BY DATE
ADDRESS hfk ()
lcil� S I-- Vw� 61 k) FIRE REVIEWED BY DATE
CITY ZIP TELEPtiONE
COMPLETE , EXEMPT ft'n An -op -
VARIANCE OR CLI SHORELINE ORADB# I INSPECTION BOND
STATE LlOtNIIE NUMBER EXPIRATION DATE I REO'D POSTED
C)o I t 0 E3YEs 13NO $
r2 tf I
0�89 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. h OSED ALLOWED PROPOSED
NEW
XRESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
muLnFAmiLy
REPAIR
GRADING CYOR
DEMOLISH
ANK
q T
GARA13E
RE NING WALL
T,
��qPORT
ROCKERY
(TYPE OF USE, BUSINESS ACTIVIM EXPLAIN:
NUMBER
NUMBEROF
0 F
DWELLING
[UNITS
STORIES
DESCRIBE WORK TO BE DONE
1
r6
LOT COVERAGE REQUIRED 8ETIBACM r.) PC SETBACKS (Fr.)
. U
PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR" UR 8 DE REAR I
COMPLIANCE OR 2
CHANGE OF USE I I
PARKING LOT AREAJ PLANNING REVIEWED BY DATE I
SIGN REaD I PROVIDED I --FIR MAEISHAI
o FENCE
X __FT) REMARKS MUST BE P R
OTHER TANK FILL, REMOVAL, OR CAP
FIRE SPRINKLER
FIRE ALARM I I
*feCHECKED
BY ITYPE OF CONSTRU ION
ME
OCCUPANT A4d
COQ9 GROUP
2/-7
CRITICAL
AREAS
'
SPECIAL INSPECTION AREA
]REMARKS
OCCUPANT
NUMBER
REQUIRED
LOAD
f
PROGRESS INSPECTIONS PER UBC
108/FINAL INSPECTION REQ'D
$
L
-
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I
Building Permit
. 7 f-1-city Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTV ONLX AM CONSTRUCTION ON THE PUBLIC
Grading
03 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SFPARATE PERMISSION.
Engr. Review
PERMffAPPLICATION: isoDAys
PERMIT LIMM I YEAR - PROVIDED WORK IS 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 OFFICLALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIM3 FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt 0
a
FROM THE 18SUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIF CE
Y, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN
NOR LIMIT IN AW WAY THE Cffr8 ABILITY TO ENFORqE ANY ORDINANCE PROVISION.-
Recording'Fee
Receipt #
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APP ROVAL
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 applicafion Is not a permit until signed by the
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
Building OhjcW or his/her Deputy: and Fees are paid, and
fOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
------ &,I
OrFICI 8 SIG RE D TE
T
SIGNffURE (OWNER 06 AGEN)V DATE SIGNED
1A0
1425)
Q I I f � t
771-02: 20
ssifliyn-fF:
A*17TENTION 43
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 BEEWGRAW?c'-'D. UBC SECTION 109 PINK -OWNER GOLD-AISESS")
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN-ACCOUW-
91.5
rim
z
0
ITI
M
C
M
r
M
ITI
Z
CO)
O�
a-0)
0
0 F;
C
C
71
z
z
0
0
11711