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USE PERMIT
CITY OF E;MONDS 111E Af NUMBER -Z-O():3
CCONSTRUCTION PERMIT APPLICATION JOB 73�20 .29,57' SV SUITE/APTip
ADDRESS
k07WNER NAMEMAME OF BUSINESS j� �D ;2A
Pa_4N e r-5 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
JJ 7L,
MAILING ADDRESS
LID FEE $
VeSj�Ar AVe.
PUBLIC RIGHT OF WAY AR OFFICIAL STREET MAP
TESCP Approv9d
Rw Permit Required
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CITY
Zip
EXISTING — PROPOSED
It Olt Use permit
Inspection Required
Sidmalk Required
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ITELEPHONE
REQUIRED DEDICATION— FT
Underground
Witing required 13
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NAME
IVIFTIER SIZE LINE Sli7NO. OF FIXTURES
PRV REQUIRED
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ADDRESS
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE
NAME CBL
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ADDRESS
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CITY ZIP I -TELEPHONE
STATE ILICENSE NUMBER
EXPIRATION DATE
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7-&*91 - 03
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
13 RESIDENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
0 CHANGE OF USE
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USINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
NUM ER OF
a
DWELLING
CRITICAL
AREAS
STORIES � *j
UNITS
NI IMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVIE-WAYS, MARQUEES, ETC.) WILL REOUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESt 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 HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS 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 C17Y 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
WORKMEN'S COMPENSATI���CE AND RCW 18.27.
SIGNA)RE (OANER OR(AGENT) DATE SIGNED
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ENGINEERING REVIEWED BY I DATE
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FIRIME 'V DATE
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VARIANIES OR CU SHOtINE Oil ADI INSPECTION BOND
REO'D POSTED
3 YES
13NO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP �� W��
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I "NING REVIEWED BY DATE
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CHECKED BY IjTYU OF CONSTRUCTION Cga"_ OCCUPANT
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REQUIRED [] YES LOAD
REMARKS
PIJOGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'DI 9
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Description
FEE
Description
Plan Check
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State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE
Fire Review g!:�- Plan Chk. Deposit
la-l&
Fire Inspection Receipt #
Landscape Insp. Total Amt. Due
Recording Fee Receipt #
APPLICATION
APPROVAL
CALL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
R INSPECTION
receipt Is acknowledged in space provided.
OWFFA IGNA DqE
1A
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771-0220
7'E_'LE AS FD B Y DATE—
EXT 1333
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IT IS UNLAWFUL TO USE OR 15CCUPY A BUILDING OR STRUCTURE UNTIL V�_
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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P TMENTOF IL NGS'"�,;�.,_
jlii UNIFORM 13UILDINCI CODE SECTION 100,
Iqig�s' WA 9801A 6 BUi1&IiIg'PermIt# 2003
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Occupancy established by this colificate: Dwelling Units: **NA**
B Umbonstruction: 11-Mr-Sprin
Maximum Occu I pai# :L"d_,
owner of Building: Stevens Magical gX$ M"i
THE Stevens AdMinistration HAS BEER
OF THE UNIFORM BUILDING CODE P* AUU_r 1'q ' 0411,1:
THE PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this
1pil
ust �remafn posftd at a
V;
4,
2003
CJ
No. Stories: 3
Basement: Yes
,1002)
I THE REQUIREMENTS OF THE JMEDITION
OF OCCUPANCY AND THE USE FOR WHICH
CHIEF BUILbING OFFICIAL
BY: -
Loll
ThIa cordlilcoft be poslied In a conspicuous pubic am WW Wall not be mnovock mulfloted or obscured wW sholl bm maInItalned In loobe condillon at A *noL Any change d occupancy of use requires a building pefn* and a now
CoVocou of Oom*ancy Issued by do City d E*r=Ws Building Mimi.
IPA PROJECT APPRQY -AL NORM,
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE .6
ENGINEERING DIVISION DATE -------.;.—
Kam$=
PLANNING DIVISION
PROJECT,ST-9VA41%
r ST S VV -2—
srrE ADDRES,
DATE INSPECTED
PERMIT —ADB#
DESCRIPTION OF WORK TO BE INSPECTED 77
A field Inspection was conducted to determine final compliance with approved plans Final approval
denotes that there are no objections from the above signed Department to the release , of
pERFO_RMANCE BONDS and the granting of : - I
)(\ GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrrH CONDITIONS N01W
13 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAHM FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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PERMIT EXPIRES 311a
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CONSTRUCTION PERMIT APPLICATION
JOB 73-2 16 �5 7- s k)
SUITEa
ADDRESS
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OWNER NAMEMME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
MAILING ADDRESS
LID FEE $
Ave. 5(ji-kc
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP
TFSCP Approved
RW Psrn-A Required
Street Use Permit Wd
.5so
CITY ZIP TELEPHONE
EXISTING —_ PROPOSED
Inspection Rewired
Sidewalk Rewired
11,e I 7, .�2? - 1130
REQUIRED DEDICATION- FT -
undarlyVind
Witing required
NAME
METER SIZE LINE SIZ��, OF FIXTURES
PFIV REQUIRED
14r,-_446�5
YESE3 NO [3
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
FA,,'Wg� 7,,-� -
NAME
CBLJ1I.
A 1,4- rfj:!�.V_
ENGINEERING REVIEWED BY / DATE
ADDRESS
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FIR 11
DATE
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CITY
ZIP
ITELEPHONE
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561t':� -V 7�'
VARIAJE OR Cu
SHORUINE OR ADIM INSPECTION BOND
STATE LICENSE NUMBER
EXPIRATION DATE I C ED B
REO'D POSTED
I 1$
LRLL!;�,d
2 Z2 EL
Ze-11 . 4�371
CIYEs 13NO
SEPA REVIEW
SIGN AREA HEIGHT
PROPERTY.TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PROPOSED ALLOWED PROPOSED
7
2 (q?
—
��
�_l own
F
EXP
NEW
RESIDENTIAL
PLUMBING / MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
ADDITION
COMMERCIAL
COMPLIANCE OR
E] CHANGE OF USE
REMODEL
MULTIFAMILY
rl SIGN
PARKING
RECYO
LOT AREA PLANNING REVIEWED By DATE
Is.
T DA10.1'
RE . FAIR
GRADING CYDS' FENCE
0 X FT)
REMARKS
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El DEMOLISH
TANK
0
0 RE'rAINING WALL F RE SPRINKLER
0
WFC
ROCKERY
FIRE ALARM
P'TY!
OWE OF11SE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY E, 0 0 N S T R U C T 10 N Cg"-j- OCCUPANT
M'0'-Xe'-1 -
I GROUP
I L01
NUMBER
OF
NU BEI R OF
DWELL NO
M
RITICAL
I AREAS
. '
SPECIAL IN SPEI
W,
OCCUPAT
STO I ES
UNITS
UMBER
REQUIRED
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REaD
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9
NeL J 7_6i1e2A,4 AW.YoVel4exlX5
1
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CjC4( C 4 le�), VALUAnON
_f I - $1jr-
Slg u, 9
DescriptIon FEE Description FEE
Plan Check / -7 -n tate Surcharge
f S -7
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: I VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
2
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION:101111 DAYS
PERMIT LIMIR I YEAR - PROVIDED WORK 18 STARTED WITHIN 160 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
;APPLICANT,
N INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
RU
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt # In, 'A
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapainsp.
Total Amt. Due 50
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVIM14.
Re . c . #
I
Reoordin g Fee
pipt
I HIEREVY ACKNO46GE T4AT I 4AVE READ'THIS APPLIC,41ON; THAT THE INFORMATION
aa�
APPLICATION APPROVAL
GIVEN IS CORREdr 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.
WILL BE EMPLOYED
CALL
This applic3lion is not a pennit untU signed by the
Building OMeW or his/her Deputy: and Fees are paid, and
TION; AND 40 NO THE WORK AUTHORIZED THEREBY, NO PERSON
IN VIOLATIONT THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowtodged In space provided.
WORKMENS COMPENSATI01AWAlik �CEAND�RCW 18,27.
OFFIO GNAT PATE
TiE� R GENI�) DATE SIGNED
SIGNATURE (0 0
_ L�j (IJ22--
771-0220
—wE�LEAs D BY DATE
'ArMNTION
JCCUPY
Off 1333
6/0-3
IT IS UNLAWFUL TO USE OR 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 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
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