20030147.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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ADDRESS
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CITY ZIP ITELEPHONE
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NAME CBL#
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ADDRESS
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CITY ZIP k I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
TAX ACCOUNT PARCEL
NEW
RESIDENTIAL
X
PLUMBING I MECH
ADDITION
COMPLIANCE OR
COMMERCIAL CHANGE OF USE
0 REMODEL
MULTIFAMILY SIGN
0 REPAIR
GRADING
CYDS
FENCE
( X—FT)
XDEMOLISH
0 TANK
—
OTHER
oGARAGE
RETAINING WALL
13
FIRE SPRINKLER
0
CARPORT
ROCKERY
FIREALARM
(TYPE OF USE. BUM
EBB OR ACTIVITY) EXPLAIN:
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NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIE�/��
IlNrrs
NUMB
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK 140C. VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTV ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATION: ISO DAYS
PERMIT UMrr I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
N 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 CITTS 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
WMKMEN'S,C0RMNdTION INSURANCE AND RCW 18.27.
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PERMIT EXPIRES
MINE
USE PERMIT
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NUMBER
JOB
ADDRESS
SUITE/APT#
PLAT NAME/SUBDIVISION NO.
NO,
LID NO.
TLOT
yc:�-,rS 19KGr AQQj T
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit R80
EXISTING — PROPOSED
inspection Required
Sidewalk Required
N'�, FT
REQUIRED DEDICATION—
underground
Wiring required 13
METER SIZE
NO* OF XTURES
PAV REQUIRED
YES E3 NO C3
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY
DATE
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FIRE REVIEWED BY
DATE
4EFM EC TION BOND
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R I'D POSTED
awalk
HEIGHT
SIGN AREA
WED
PROPOSED
III EBORMED SETBACKS (Fr.)
kLATED ftla US LIR SIDE REAR
E 131118317 H NA"
WA MMPDjj,*PPWT6b=W0T=VATE
REQ`D I PROVIDE
CHECKED BY ITYP ON c9F.7 OccuPANTf,
I IY- GROUP
SPECtALINSPECTIOW- AREA OCCUPANT
REQUIRED r LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG-D I
1
$
I
- -
Descirlption
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
Fd
City Surcharge
_/SL
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
rIM,
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt # _903'a
Landscape Insp.
Total Amt. Due
Recording Fee
T-
Receipt #
CALL
FOR INSPECTION
JA
k425)
771-0220
EXT 1333
APPWATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
receipt Is acknowledged in space provided.
OFFICIALS SIQ)YATURE I n1,TE
e—
RELEASffD'BY t DATE
1
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
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FAX NO. Feb. 03 2003 10:15AM P2
FROM A
Agency t.I NO- 110 Union Strcct, Suite 500
X-: Saitle, WA 98101-203 9 -Tl t)003
2003 '11 654 www-psckmair-orz Nri
1,40TICE OF NTENT Agency Else 0"1Y
Agency Use oidy
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Asbestos RemOv. Demolitt
U Asba
A. ftpject — -I - OG -7 7 9,S- 7S
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Pro e
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111151317RIJUMMI701114 WMA. A111"Pil0l Imo
Q A&I coutmetor
Contractor.
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qa1lin Address.- 3
State: r-J
City: -Se- IL (g
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FD. Site MT.
Addrem: -72-
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site Local Phone:
le Asbestos Identified9 -wa—u—No
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am Asbestos Y";
63 was F
best" Survey or No. of Was Nonfixiable Asbestos Id UYes NNO
U m swacwres: was condumd: � a copy of the survey, if 11OUI asbestos is
Milo" dc&V identified or if no asbestos is identified on surveY-
AFIERA Building L, �- _A�L�A; J 0
wpm
sat: - Ditte Ci State,
—irication No.. --`--ing Fire (List Fire Dept -
Pep No. of train F ition (attach COPY Of
NO —in —.. -I - s=-. 2. U Ordered Deml
T.;f0rJmkUon-- Date' MA, 06 k -no le asbestos be left in place fting ddn0? U Yes ML NO]
Demufm _d4moltdon CIO -S mawns addr= on Lvck ' W
Tf yes, Ust type and qty.
coixuactor. be -
Work Days; M T W Th F Sa Su
rm ' IctionDate: Hours,
Stari61 Will all friable
Total unearpt. ? �umre Ft, _rnaterials be ret-
-QVI to be Otha-.
�Duct Ins. U1 Pipe Ins.
S CF—comm4 Coafings Other.
Ffirproofins— LJ Paim Li Ph=
S Nat'l. i"S or Roofing Mat'l Oftr-
Vmisc. mat'l Cemmit Bd.
lidan Pr9ject categories: basmt1-oB&xLq—d As Damoution
IL �to Lrsusle &msba=
1. Sm May Residence; A- Prior Notice
bes 5 ReIn0val Project Only 10 Days* B.'$50
Prqlect (with or without asbestos mwv3l Project) B.
D s remyal can begim . notificatiou; demlition niust wait l0J!=1
in= - - $200
2. CHher DeMliti0m With No,-Asbcstos Removal Project V1 50 S50
feet of asbe (see back)
3. U a 10 - 259 lin= feet Or 2t 48 - 159 10 DAVG�l S300 sloo
umI as tos 0
__ar feet or 16, $750
4. C3 2 - qq!�pline - 0 - 4."9.s ays
LJ III ....... ..... III ........................... or 5-000 - 49,999 !Iuare feet 0 &sbestox -g2—.000
5. !1 111 010C 9,999 1 A This _$1.000
6. >.I 00() limar feet or> 50.000 s5uW*f&15t 01asbeltos PriorNotice reject Fee
7. U —Emtrg=CY AsbCA03 PrOJOCt Or U Emrgemy Dem I W0121
in fee: howev-- nfoomiy 10
(Single-FwnilY Itclidences are eXAm fmm & Co letme. A e se
ml dam ig. to the best of VW JtnowledM 1=U
L t the infOOlmd0a Clmtwp in
inr
Reviewed
Date Y
APR 1 12003
puge soomd Clean Air As",ey Form No.: 6&160(Rcvi90d9/01)TS . DEVELOPMEtJ SERVICES GTR-
r,ITY OF EDMONDS
FINAL PROJECT APPROVAL FORM
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.doc.l:tenV:bldg:formsIO/OI
RECORD
OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ............. .:; ..........
FOUNDATION:
Footing......................
Wall .......................
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Pier/Porch .................
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w 11"
Retaining.. a ............
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Insulation .......
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PLUMBING:
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Undergroun ...................
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_. A VDATE RECEIVED
(77'
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER 2-CO'
:5
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
ex —VL, Al'lletr
SUITE/APT#
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT
LID NO.
A CJ
T-� L V_
I
MAILING ADDRESS
Q,:;-�-r,
Fir,r tNoi:)t
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1
LID FEE $
El / �' ��
WBUC RIGHT OF WAY PER OFFICIAL STREET MAP
TESGF APP(O"d
RW Pawl Required
Streetila-PermhReq'd
ZIP 'HON
CZ
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EXISTING — PROPOSED
REQUIRED DEDICATION FT —
Inspection Required
Sidewalk Req Ifed
Underground
- WIMg required
NA�
_i6
ILI?
METER SIZE LlNf.SIZE NO. OFQ�!URES
PRV REQUIRED
YES NO z
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__rC
E ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
-S (A' t'
RIM"D CA91.0t9IFLUL
CITY
U.Iun
ZIP ITELEPHONE
9?67.21
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NAME
CBLN
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ENGINEERING REVIEWED BY
DATE
ADDRESS
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FIRE REVIEWED BY
DATE
. CITY*
ZIP , I TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
BY
SHORELINEORADB# INS BOND
VARIANCE ON4 REO'D POSTED
ICHECKED
OyEs
ONO S
SEPA REVIEW SIGN AREA
_]"�%PWE'D
G
HEIGHT
PRONRTY TAX ACCOUNT PARCEL NO.
COMPLETE , EXEMPT PROPOSED
ALLOWED PROPOSED
NEW
RESIDENTIAL
1:1 PLUMBING / MECH
LOT COVERAGE REQUIRED S&41LACKS (Fr.)
ALLOWED PROPOSED FRONT SIDEN%K
PROPOSED SETBACKS (Fr)
L/R SIDE REAR
0 ADDITION
0 COMMERCIAL
COMPLIANCE OR
1:1
I
LFRONT
9
CHANGE OF USE
REMODEL
MULTIFAMILT
0 SIGN
PARKING L9T AREA PLANNING REVI
RECID PR E a
DATE
GRADING
FENCE
13
REPAIR
CYDS
( X
Fr)
-MOL I'
DEMOLISH
Lr
TANK
OTHER
1:1
10:1
RETAININGWALL
0.
F RE SPRINKLER
CARPOR
RPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BMNEE93
OR ACTIVIITY) EXPLAIN:
CHECKED BY TYP=O N
OCCUPANT
GRO
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIALINSPECTION JAREA
OCCUPANT
LOAD
STORIE���
UNITS
NUMB
REQUIRED rl YES
DEscRf6E WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECIP0
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Description FEE Description FEE 9
Plan Check State Surcharge 0
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLM CHECK 140,- VESTED DATE Plumbing
Mechanical
THIS PERUrr AUTHORLZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOUNN (CURBS, SIDEWALKS, DRIVEWAYS, UARQUEES, ETC.) WILL REQUIRE
�SEPARATE PERMISSION.
PEMMITAPPILIC . ATION: � 180 DAYS Engr. Review
PERMIT LIMM 1 YIEML PROVIDED WORK 18 STARTED WITHIN 1180DAYS Engr. Inspection
SEE BACK OF PINK PERPAIT FOR MORE INFORMATION
evi
'APPLICANT, ON BEHALF OF HIS OR HER SPbUSV, HEIRS, ASSIGNS AND SUCCESbR� Fire. R ew Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND IAND'HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND Fire Inspection Receipt IV
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 Landscappinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I Recording Fee Receipt #
I HERE13Y 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 APPLICATION APPROVAL
THE OWNER. DIAGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit unfit aignod by the
TION; AND IN OING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are pald, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknovAodged In spare provided.
e!�XMElTr.3rF%4#T1ON INSURANCE AND RCW 18.27. kTE
A OFFICIALS SIGrATURE /D)
R (OWNE AG D ED 1A9
%425)
7T / I D&E
2"" 771-0220 RE`LEASEb'oY
NTION EXT 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 - INSPECTO'A IN 1
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES