20030165 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
C A EK
CITY ZIP TELEPHONE
6 f?A4 0 AJ,0 S q CA30 ZCD vi;- 7 'PE; -Z-L 7
NAME
ADDRESS
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CITY ZIP TELEPHONE
PERMIT EXPIRES
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USE PERMIT
ZONE NUMBER 0_1
JOB SUITE/APT#
ADDRESS /Z00 I
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET 6P
I
TESCP;7P1o1-d
RW Permit Required
Street Use Permit Raq'd
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Un :,-ul,
1, �
W"T
METER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES[3 NO 13
NAME
S VU, E.>�6 14 A LO INC-
CBLN
ADDRESS
4ec) P1.0
CITY zip
TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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13AA1961 V-10qq DR
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PROPERTY TAX ACCOUNT PARCEIL-.NO.
0 0154,4 (0 0,000400
80
4:Z�NEW
I.."—
rff-RESIDENTIAL
PLUMBING / MECH
0 ADDITION
.
'0 COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MUL11FAMILY
SIGN
G
0 REPAIR CYDS
,?&%
E
F NCE
( X FT)
DEMOLISH TANK
OTHER
GARAGE RETAININGWALL
CARPORT 1_3 ROCKERY
FIRE SPRINKLER
FIREALARM
CrYPE OF USE, BUSINESS OR AC"M 0"N:
NUMBER NUMBER OF CRITICAL
DWELLING AREAS
OF UNITS NUMBER
STORIES Z> I
DESCRIBE WORK TO BE DONE
T
MNM— 16
orewo — IuLq
HEAT SOURCE GLAZING % LOT SLOPE %
HECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION.
PERMIT APPILICATION: ISO DAYS
CL PERMIT ILIMM 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
IN 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
SSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
E MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 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 CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATIO R CODE OF THE STATE OF WASHINGTON RELATING TO
S WNJ
P % LABJQ
TIO
WORKIEN P TION INSURANCE AND RCW 18.27.
ry 1,TEWNVEA
BIG 1E �/O
G DATE SIGNED
.� I . �r_ I - Z 7-04--
0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGI NEERING FIEVI EWED By, DATE
FIRE REVIEWED BY DATE W
lz
VARIANCE OR CU SHORELINE OR ADS# INSPECTION IS BOND
.REO'D POSTED
13YES 13NO
SEPA REVIEW SIGN AREA,"
HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED, —ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SMACKS 'PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FROINIT, UR SIDE REAR
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PARKING LOT AREA. I PLANNING REVIEWED B'k DATE
RECYO I PROVIDED I I
REMARKS
CHECKED 13Y Ty
V.�USTRUCTION
I ry
SPECIAL INSPECTION rA
REQUIRED
-
REMARKS
PROGRESS INSPECTIONS PER UBC
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
GROUP A
OCCUPANT
LOAD
2
INSPECTION REGT g
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-FEE Description FEE
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official of histhOr DOPUtY: and Fees are paid, and
receipt Is acknowledged In space provided.
Mt-IMQ -,1(L4ATl1nF J , DATE )
BY
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
09/UQ PRESS HARD -YOU ARE MAKING 4 COPIES
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DATE RECEIVkJ
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USE 09:93111,111IT 4,
ZONE J��J2_ -
CITY OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 12cla LA-)
OWNER NAMEINAME OF BUSINESS
F�kAo6HA,-u ( r,,s c, - PLAT NAMFUSUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
TESCP Apr=
9- 11 C A i'� PUBLIC RIGHT OF WAY PER OFFICIAL STREET 4AP RW Porrrot
Street Use Parmit ReqA
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspecilor' Required
Sidewalk Required
REQUIRED DEDICATION— FT Undertiround
A.) 8 cj -z, o 1 4- z-S- 7 7:S� - -7 WIttrigrequired 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
ADDRESS
s -1- -6
CITY
NAME
L-51KIII, 061
ADDRESS
,qll CAI&
a
J ('Z-A L� S ug, tA S YES 13 NO 13 z
REMARKS
V_ C� 77- OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ZIP TELEPHONE
CBL#
& (" 5- .1, 1
—ENGINEERING REVIEWED BY DATE
V A.L.
CITY ZIP
TELEPHONE
61) A/) c) r�v el LPo-�,o
1 4,7,--, - -7 7;:��- cr"7
STATE LICENSE NUMBER EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
0 6 (, c, o o 0 (e) 0
JXNEW a -RESIDENTIAL PLUMBING I MECH
COMPLIANCE OR
ADDITION 0 COMMERCIAL CHANGE OF USE
REMODEL 0 MULTIFAMILY SIGN
REPAIR FEN CE
CYDS x FT)
0 DEMOLISH TANK OTHER
CUUVAE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
UWE OF USE, BUSINE88 OR ACTIVIM EXP N:
NUMBER -N
OF
CRr
r
OF
�To'
STORIES
DNUMBER
WELLING
UNITS
ARE
IJU&
DESCRIBE WORK TO BE DONE
FIRE REVIEWED BY
DATE I ICI
VARIANCE OR CU SHORELINE ORADB#. I INSPECTION I BOND
REO'D POSTED
13YEs 13NO S
SEPA REVIEW N AREA HEIGHT
SIGN AR
r
P
j,Rj�SEDD A LUL
OPO
COMPLETE EXE OPOSED OWED PROPOSED
PR
___XP R OEQ R E D CK
LOT COVERAGE a POSED SETBACKS (Fr.)
T r
, 5 C
ALLOWED PROPOSED FRONT SIDE ONT LIRSIDE REAR
I .
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I C6
LE
CHECKED BY JTY��NST LICTION CODE
Ono
occu`��Ii&
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [,9etES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 10WFINAL INSPECTION REG-D
N
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VALUATION
$
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE% Building Permit
VESTED DATE Plumbing
Mechanical
City Surcharge
115—
PLAN CHECK NO:
Base Fee
THIS PERMIT AUTHORI3!E8 ONLY THE WORK NOTED. 'THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLZ ANY CONSTRUCTION ON THE PUBLIC
DOUNN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) VALL REQUIRE Grading
3 SEPARATE PERMISSION.
t: Engr. Review
PERMITAPPUCATION: 160DAYS
PERMff LIMIr I YEAR - PROVIDED WORK 18 STARTED WITHIN 180DAYS 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 INDEMNIFX 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 Fire Inspection Receipt #
FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due jq
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* 6. a
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 19 COARECII AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Oftlall or h1riltior Deputy: and Fees are paid, and
IN VIOLATIO 1E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMENS ;gPZATION INSURANCE AND RCW 18.27.
OFFICIAO SIOPATURE E
SIG RE . NER OR)JRG DATE SIGNED IA-95)
IjiU
771-022 ".x DP�E
0 RELEASED BY
A*17TENTION 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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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