20030162.pdfDATE RECEIVED
['PERMIT EXPIRES
CITY OF EDMONDS
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USE PERMIT
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NUMBER Z 00
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CONSTRUCTION PERMIT APPLICATION
JOB 7,5X9-,z16:Ff- 50 SUITEIAPT#
ADDRESS
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OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. �OT NO. LID NO.
[-`r11-KA7'_2q LID FEE S
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permit R i d
Street Use Permit Req'd
CITY ZIP TELEPHONE
EXISTING - PROPOSED InspecOon Required 13
Sidewalk Required 13
Underground
REQUIRED DEDICATION- Fr wiring required 13
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO 13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE 7'
NAME C)�
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ENGINEERING REVIEWED BY DATE
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CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
VARIAN OR CU SHOR NE OR AOB# INSPECTION
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TAX AC COUNT PARCEL NO.
SEPA REVIEW SIGN AREA
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
gPERTY
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EXP
NEW RESIDENTIAL PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
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PLANNING REVIEWED BY D TE
PARKING LOT AREA T
0 REMODEL MULTIFAMILY SIGN
PROV IDED
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0 REPAIR GRADING CYDS FENCE X Fr)
REMARKS FT
DEMOLISH TANK
o GARAGE 0 RETAININGWALL F RE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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CHECKED BY ITYPE F CONSTRU CCUPANT
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NUMBER NUMBER OF CRITICAL
OF G A EAS
DWELL N
AREA OCCUPANT
SPECIAL INSPECTION LOAD
STORIE9;-A UNITS NUMBER
REQUIRED [:] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD.
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VALUATION
Description
FEE
Description
FEE
Plan Check
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State Surcharge
HEAT SOURCE _F__G LAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: " DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: ISO DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK 15 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
THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total A 1. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt # -17 1 e-7 &q
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-
This application Is not a permit until signed by the
CALL Building Official or his/her Deputy: and Foos are paid, and
TION; AND IN DOING THE UTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA�R CO OF THE STATE OF WASHINGTON RELATING TO
ACE
FOR INSPECTION
receipt Is acknowledged In space proyidod.___
WORKMEN'S C)MPENS AND RCW 18.27.
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SIGNATURE (OWNER AG07M DATE SIGNED
1210r.
QRE
MIGN
Ant It WINNEVE
!20
771-02
DATE
ENTION
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
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FINAIOROJECT APPROVAL FOIL
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DEPARTMENT OF BUII rup it te.
PER UNIFORM BUILDING CODE SECTION'109
ullding Permit
Occupancy established by this Cart I ificate: Dwelling Units: **NA**
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Owner of Building:
THE Stevens Mec
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Maximum Occupiht Load
Room ' ?Papacity signs,
No. Stories: 3
on;.11.1.Hr-Sprink I Basement: Yon
Per.U.B.C. 1002)
posted at aff times.
QIVI!�LYING WITH THE REQUIREMENTA ng:,ruc 4nnly
RL.TKP,.
IM15. Umirumm OUILUINU GUM A&AR91PTED qY T�E CtT�,,fo ,OkOIJP,A D DIVISION OF OCCUPANCY AND THE USE FOR
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WHICH THE PROPOSED OCCUPANCY IS CLASSIF11E1J.','.-'�
Issued this &Qlh ..'Oay'o'f June 2003
CHIEF BUILDING OFFICIAL
BY: 9PAPPZ4
1Ws cortiffeate shall be posted In a conspicuous publIc area and shall not be removed, mutilated or obscured and shall be maintained In legible conclition at all times. Any change of occupancy or use requires a building Permit and a new
CsffficstG Of Occupancy Issued by the City of Edmonds Building Offlclal.
3ATE
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FCCITY OFEDIVIONDS
CONSTRUCTION PERMIT APPLICATION
F-1 OWNER NAMENAME OF BUSINESS
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MAILING ADDRESS
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—6-IT—Y Zip TELEPHON
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NAME
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CITY ZIP TELEPHONE
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NAME
ADDRESS 4V
flv,_�2 /0111r_ 51 (100 Ax W17)
CITY ZIP TELEPHONE
V—/ 9y9e7_1 150
STATE LICENSE NUMBER EXPIRATION DA
elk7-11_4 7-d- 0
P PERTY TAX ACCOUNT PARCEL NO.
9
NEW
RESIDENTIAL
1:3 ADDITION
COMMERCIAL
REMODEL
0 muLnFAMILY
REPAIR
GRADING CYDS
13 DEMOLISH
0 TANK
[3 GARAGE
o RETAINING WALL
CARPORT
ROCKERY
(ME OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
UMBER OF
OF
DWELLING
.8T RIEIIt-.,)
UNITS
DESCRI13E WORK TO BE DONE
[PERMITEX-
USE PERMIT
ZONE NUMBER
J013 :5U SUITEIAPT#
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW POMIAPR led
,treat Use Peffnh Reqd
EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT Underground
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
YES [3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
I __ ID
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c� U ENGINEERING REVIEWED BY DATE
7- L17-10 I--
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VAR U SHORtfn INSPECTION BOND
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leSEPA REVIEW SIGN AREA OYES WO 1$ HEIGHT
COMPLETE - EXEMPT ALLOWED PROPOSED I Al I OWED . PROPOSED
I LOT COVERAGE I REQUIRED ACKS (7) PROPOSED SETBACKS (FT)
PLUMBING / MECH ALLOWED PROPOSED FRONT SM REA FRONT URSIDE REAR
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COMPLIANCE OR z
CHANGE OF USE
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PARKING LOT AREA I P�ANNING REVIEWED BY E
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( x FT) REMARKS
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[3 FIRE SPRINKLER
FIRE ALARM
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CHECKED BY I TYPE OF CONSTRU
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CRITICAL
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'rAREA
AREAS
SPECIAL INSPECTI )N
OCCUPAVI'm
NUMBER
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REa
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VALUATION
$
Description FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit ity Surcharge
Ch
PLAN CHECK NO: VESTED DATE Plumbing
I
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I
Mechanical
Ur LIV
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPEFnY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOUAIN (CURBS, SIDEWALKS, DRINIEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMTTAPPUCATION: ISO DAYS
PERMIT 1.111111111 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PEFIMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SFOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
.0
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
tv—
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapainsp,
Total Amt. Due
DEEMED TO MODIFV; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CffY`8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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I
Recordin g 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 C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit untill signed by the
TION; AND IN DOING THE WOR&AUTHIORIZED THEREBY. NO PERSON WILL BE EMPLOYED
"ding Offictal of histher Deputy: and Fees we paid, and
IN VIOLATION OF THE LABdIT-C-0bg OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECT ON
receipt Is ackno%riodged In space peovided.
WORKMEN'$ COMPENSPISITft�RAVCE AND RCW 18.27.
"M
SIG E (OW NER C� AGENT)
I Py\
DATE SIGNED
Q '& 2,
1
.
771-0220
DATE
RML,
_--iiiiiiicitI�2
A*17TENTION i EXTI 3
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
^^nlc GREEN - ACCOUNTING
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