20030154.pdfM
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS'
Low
MAILING ADDRESS
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NAME
ADDRESS
CITY ZIP ITELEPHONE
PERMIT EXPIRES
IISE PERMIT U�,0157
ZONE NUMBER
JOB SUITFJAPT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
PID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW ParmA Rewired
Street Ues Poffnit Raq�d
EXISTING — PROPOSED
Inspection Required
Sidewalk Rewired
REQUIRED DEDICATION— FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
I
I YES 13 �NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
NAME Lr
OBSERVED BY CITY INSPEGMR
ENGINEERING REv'EwERFIDAVITS SMLL NOIATE
ADDRESS
4o 5Mk,_=& ��— zS L..) I FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
PIRATION DATE
0 By
REO'D
113YEs
POSTED
ONO
0A
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BEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
, ALLOWED PROPOSED
,
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
-PROPOSED SETBACKS (Fr.)
M-I'LUMBING / MECH
ALLOWED PAOPOSED
FRONT SIDE REAR
FRONT
LIRSIDE REAR
COMPLIANCEOR
CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED, By
DATE
SIGN
RE110 I
PROVIDED
I
FENCE
( — X—FT)
REMARKS
OTHER
FIRE SPRINKLER
FIRE ALARM
STATE LICENSE NUMBER
EX
PROPERTY TAX ACCOUNT
NEW
RESIDENTIAL
ADDITION
'lirCOMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
13 TANK
GARAGE
CARPORT
0 RETAINING WALL
ROCKERY
BU SA
(TYPE OF USE. )M1!7)7rC
LAIN:
NUMBER
OF
NUMBER OF
DWELLING
UNITS
—STORIES
DESCRIBE WORK TO BE DONE
CHECKED BY ITYP C I C UPANT
IJAREA CCU P
CRITICAL GROU jc>
AREAS SPECIAL INSPECTION REA OCCUPANT
NUMBER REQUIRED [3 YES ELOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
W 06-j I i!�)K
% LOT SLOPE %
$ E
DescrIpUon FEE
Plan Check
Buildim Permit
Description FEE
State Surcharge
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
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0050p, -
THIS PERMIT ALITHORCM6 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE WNE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
I
9
Engr. Review
PERMITAPPUCATION: 180 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STMITED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
;APPLICANT
N INTEREWAGREES 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
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
I
NOR LIMIT IN ANY WAY THE CITY'S 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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building OfflcW or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THWOOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMCE AND RCW 18,27.
OFFICIALS q"TjV1REe DAIE I
SIGNATURE
-
DATE SIGNEV,
11, A, 2 5)
1 AVII I
SNW,
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771-022 0
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REL4EASED
ATTOENTION
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 100
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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PATE RECEIVED
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PERMIT EXPIRES
I. I L9
CITY OF tDMONDS
ZONE
PERMIT IZO�_
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITEIAPT#
ADDRESS
OWNER NAMENAME OF BUSINESS
OTNO.
PLAT NAMEISUBDIVISION NO. LOT NO.
MAILING ADDRESS
/-4 7 V7 btw-Ve-, ke t)
LID FEE S
IES��
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW
CITY E
Zip
&,IT:%
EXISTING —
suw Uss P&mk RW
PROPOSED kopectlon8squkod
6WW10A RaWked
Undwomund
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T �JL 7 03
2E& .a.
REQUIRED DEDICATION— FT
Wkingrequko 13
NAME
METER SIZE
LINE SIZE 0. OF FIXTURES PRV REQUIRED
YES 1:1 NO 93
1
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
I..
CITY ZIP TELEPHONE
- I I
NAME CBL I Pq
--- m
OL-
"ADDRESS
assem Ciff INS
ENGINEERING REVIEWED BY INDA$M 3 MLL or
4
60 3 S71L,-__sAt)a-
BE MEMO
FIRE REVIEWED BY
DATE
CITY ZIP TELEPHONE
-1
5�
IE
TL_Ls-
10 1 C?06 —7g,�
STATE LICENSE NUMBER PIRATION DATE�
VARIANCE OR Cu
SHORELINE OR ADBO INSPECTION BOND
REGID POSTED
I I
13YES ONO s
SEPA REVIEW
SIGN AREA HEIGHTL
PROPERTY )UNT PARCEL -NO.
62
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
[3 NEW' RESIDENTIAL MBING I MECH
ArPLU
LOT COVERAGE
ALLOWED
REQUIRED SETBACKS (Fr) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT LIRSIDE, REAR
PROPOSED
3 ADDITION MMERCLAL COMPLIANCE OR
WCO OF USE
CHANGE
REMODEL MULTIFAMILY SIGN
PARKING
REOD PROVIDED
LOT AREA LANNING REVIEWED BY 'DATE
REPAIR GRADING 0 FENCE
AA
CYDS X FT)
REMARKS
OTHER
DEMOLISH [3 TANK In
Inks 116
0 GARAGE o RETAJNINGWALL., 0 FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
OWE OF USE.. LAIN:
CHECKED P
OCCUPANT -
7
GROUP,
1 �6
NUMBER N ILI CRITICAL
UM R OF
—
WE NO AREAS .......
OF D E
SPECIAL INSPECTION
OCCUPANT
STORIES UNITS NUMBER
REQUIRED [:1 YES
JAREA
LOAD
DESCRIBE WORK TO ISE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECIP0
C; t-j C7. s 7c--> 113 01k� V
AW___ OF 0100)6
VALUAnON
Deacriptlon
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLA23NO % LOT SLOPE %
Bu#ftaPormft
City Surcharge
e-_2
L60
PLAN CHECK NO: VESTED DATE
Plumbin
g2)
THIS PERMIT AUTHOR&MB ONLY THE WORK NOTED. Tmis PERmnr COVERS WORK TO
t:
2
BE DOME ON PRIVATE 1PROPEFM ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
3
DOMAIN (CURBS. INDEWALKS, DRIWINAM UAnQUEES, ETC.) WILL REWIRE
SEV�FLATEPERMISSION.
PERMITA , 10C
)�qr. Review
M&T AADRAIVEl"IN 1150 DAYS
PERMIT LIMM I YEAR - PROW ORKIS 'E�4. Inspection
BEE 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 CRY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIREC71Y OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMff. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapoinsp.
Total Amt. Due
DEEMEDTO M0DIF% WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PRomm'
Recording Fee
11
7 ---
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
AUTHORIZED AGENT OF
--J!=,Pl
APP.LICATION
IPROVAL
APPROVAL
GIVEN is CORRECT: AND THAT I AM THE OWNER. OR THE DULY
THE OWNER. I AGREE TO COMP1Y WITH CRY AND STATE LAWS REGULATING CONSTRUC_
CALL
TNs appWOon ho not i pe(AV19f*W signed by the
Waned by th,
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION TH BOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR iNsOictibii
Iding dfkw 6f Now OfpUtj�.Jk��o Foos are paid, and
Ew � receOt Is alcknoWedged Intom provided.
WORKMENS CO CE AND RCW 18.27.
OFFICIALS RE� DAIE
BIG U
DATE SlGNE
140%
b NMZe- 0�
0--j=--
771-0220
q/4/
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RELE BE Y
ATTNTION
EXr 1333
-------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INbFI:U I IUN HAIJ UhhN MAUh ANU AVI'KUV`AL UK A Uttl 11101- onIGINAL - 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