20030173.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME NESS
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OF
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cl ZIP & TELEPHONE
NAME
If
ZIP
76
E ICBL#
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L 41
ZIP
TELEPHONE
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LICENSE NUMBER
EXPIRATIO DATE
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TAX ACCOUNT PARCEL NO.
( I 0� I I PERMIT EXPIRES
USE PERMIT
ZONE NUMBERC
JOB
SUITE/APT#
ADDRESS
U2,2 — -az
PLAT NAME/SUBDIVISION NO. "I
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APR7.�d�
RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION—
FT
Underwound
Wiring required 13
METER SIZE
�E77NO.
OF FIXTURES
PRV REQUIRED
0
YES9 NO C3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE 110
VARIANCE OR CLI SHORELINE OR ADB11 I INSPECTION 1$ BOND
REO'D POSTED
13YES ONO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED
15 S( C/
6 'o o - e,
EXP
Off"NEW
RESIDENTIAL
E?VLUMBING M17ECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (170
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
2
ADDITION
MERCLAL
COMPLIANCE OR
9
CHANGE OF USE
z
REMODEL
MULTIFAMILY
I
SIGN
PARKING
REO'D I PROVIDED
LOT AREA PLANNING REVIEWED BY DATE
REPAIR
GRADING
13 CYDS
o FENCE
( _X—FT)
REMARKS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAININGWALL
ROCKERY
F RE SPRINKLER
F19EALARM
F USE. BUISINESS A LAIN:
MI.
7
IR
CHECKED BYTTYPE
GROUP
OF CONSTRUCTIOTT"'F OCCUPANI�?
I
IFL�
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P 9
humadA
OF
N BEff
0 UM LL
A)IJ4
C RITICAL
AREAS el "
K/8
SPECIAL INSPECTION
OCCUPANT
LOAD
STORIES
UWE
NITS
REQUIRED [] YES
JAREA
DfigghIBE ORK 61
DONE
I
REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REaD
f
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
City Surcharge
PLAN CHECK Nllje�N -2
( 22 --OL
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONCY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
I:
Engr. Review
PERMITAPPLICATION: 1130 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I
'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
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR
0 NOR LIMIT IN ANY WAY THE CrIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
X1
Recording Fee
Receipt #
L,6"?
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-
CALL
This applica0an Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LAA�� OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowiedgad in space provided.
WORKMEN'S COMPENYAgRINS RARGE AND RCW 18.27.
DATE
--9%90MJqE (OWNER
IE
1405)
%-Wlr-
3MM4 31-7103
321115- �Lc
771-0220
RELE 611113 BY DATE
ATTENTON
M 1333
/%W1
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
M
a 4h
I
0
V
ATE RECEIVE9
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBE��a—(�'/
CONSTRUCTION PERMIT APPLICATION JOB SUnVAff#,!We
ADDRESS
onNAME/N NESS
Q�_ 77 OF Wffl PLAT NAME/SUBDIVISION NO. LID NO.
77 LID FEE S
i0_4FG AULr 5
TESCP APPMVW
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Wd
EXISTING - PROPOSED Inspection Required
cl ZIP LLEPHONE Sidewalk Required
REQUIRED DEDICATION- FT Underground
Wiring faquinsd d
METER SIZE LINE SIZE NO. OF FIXTURES� PRV REQUIRED
E YESX NO 13 OLE
ry aAeejl��e_ I
ADDRt "o, 04 REMARKS
S� -j4 OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
ZIP ITELEPHONE
z a 41ib
NAME CBL#
ENGINEERING REVIEWED BY DATE
ADDRESS
�40 0 FIRE REVIEWED BY DATE
CIT TELE
ZIP PHONE
sew
9_� & ;9. -9-74-7 BOND
VARIANCE OR CU SHORELINE ORADS11 INSPECTION
CEASE NUMBER EXPIRAT 0 ATE 9PVCKE REO'D POSTED
14 1 3 OYES ONO is
lopr=13= 70 $EPA REVIEW SIGN AREA HEIGHT
F111OPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
—7 EXP
LOT COVERAGE IRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
[ff"NEW RESIDENTIAL., 1LUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR z
0 ADDITION M.-tOMMERCIAL 0 CHANGE OF USE
PARKING LOT AREA LANNING REVIEWED BY DATE
1:1 REMODEL MULnFAMlI.Y SIGN REO-O PROV ED
ID
GRADING FENCE 1%�&
0 REPAIR 13 CYD�f 0 ( X _ FT) REMARKS I I I
[:] OTHER 81
DEMOLISH TANK
GARAGE 01 RETAININGWALL F RE SPRINKLER
CARPORT ROCKERY FIFIE ALARM
n=R A37 CHECKED BY I T'�PE OF CbNSTRUCTION COU OCCUPA�
GROUP
AUMBdk NUMB CRITICA WV 5; e R I yk I -
OF DWELL AREAS SPECIAL INSPECTIO OCCUPANT
STORIES UNITS [NUMBER REQUIRED [] YES LOAD
GRK M Bd DONE
V-'4'V 4 REMARKS
PROGRESS INSPECTIONS PER UBC 1 08/FINAL INSPECU1.
AA
k
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECKR VESTED DATE
r)3 —OLEs,
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, ORP&VAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCAIV*- 80 DAYS
PERMIT UMM I YEAR - PROVIDED WO'A" 10AMM11vilTHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICAK, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY U,
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 CITVS 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 F OF THE STATE OF WASHINGTON RELATING TO
WORKMENS CO U AND RCW 18.27.
a E (OWNER DATE NE9
p
m4eA — ( , "71i g I
Description
FEE
Description
FEIT"
Plan Check
State Surcharge
Building Permit
16� Surcharge
Plumbing
Mechanical
Grading
E22r. Review
r
ngr. Inspection
Fire Review
Plan Chk. Deposit
I
Fire Inspection
Receipt #
I
11
Landscapoinsp.
Total Amt. Due A
-
Recording Fee
Receipt #
L2C Z
CALL
FOR INSPECTION
L ,
1A25)
771-0220
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building official or his/her Dcputy: and Fees are paid, and
receipt is acknoWledged in space provided.
I OF WIGSN. DATE
4 3/4)C>3
-0
F*R—'E L4 0 By DATE
A71EW10N "T"I 33 . , :��7/&4
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL MWWWMZ& �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