20030185.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS PM7
15
MAILING ADDRESS
1-2312
"
1
Z-4-m
'cRA—ME
ge.
El
ADDRESS
ZIP ITELEPHONE
CITY ZIP
NAME
ADDRESS
PERMIT EXPIRES
USE ,��ERMIT
ZONE NUMBET0,0S —elgS
JOB SUITE/APT#
ADDRESS 22� LLZ��
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Rsqd
EXISTING - PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT UnderWound
13
METER SIZE LINE SIZ 0. OF FIXTURES PRV REQUIRED
ES13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CBL # I
A III ENGINEERING REVIEWED BY
CITY ZIP TELEPHONE
Awtmb_6 OW - —
STATE LICENSE NUMBER EXPIRATIOVWI."E* BY
ROPERTY TAX ACCOUNT PARCEL NO.
390'f
QQ2 45
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
f] COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
ULTIFAMILY
SIGN
X
L_VM
REPAIR
I
GRADING
CYDS
C] FENCE
X FT)
DEMOLISH
TANK
[3 OTHER
GARAGE
RETAJNINGWAL�__
FIRE SPRINKLER
CARPORIT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINES4 OR &CTWM EXPLAIN:
AX D 0
NUMBER'
OF
UMBER OF
NW
D ELUNG
CRITICAL
AREAS
STORII
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU --rREUNE
SHO OR ADB#
I INSPECTION
BOND
REQ'D
POSTED
IS
1*S 13NO
BEIRA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
:.AJLOWED PROPOIED
, x
"XP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRON T LIR SIDE REAR
z
A A
A
ATE
PARKING
LOT AREA
PWlf6G REVIPED,
REQ`D I PROVIDED
—1 -
CS11 C-10 mobf_=_
CHECKED BY ITYPMr RrQN GC7 L; rANIK/
GROUP
S - PECLAL INSPECTION JAREA OCCUPANT
LOAD
REQUIRED 0 YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D I
ja
VALUATION
(,7
$
Description
FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO- 10A VESTED DATE
n
Plumbing
Mechanical
THIS PERMrF AUTHORUMS ONLY THE WORK NOTED. THIS PERMrT COVERS WORK TO
h BE DONE ON PRIVATE PROPERTY ONLY. A.W CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: 160DAYS
C6 PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PEnurr FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspedon
ALL CLAJMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
91 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
1 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-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CCAE OF THE STATE OF WASHINGTON RELATING To
FOR INSPECTION
WORKMENA COMPENSATION INSONANCE AND RCW 18.27.
rl
F
SIG U (OWNER DATE SIGNED
0 A E
A^
(425)
771-0220
EXT 1333
Description FEE
State Surcharge
City Surcharge I
,e,n 1,11
Plan Chk. Deposit fit/ —
Receipt # P�u
Total Amt. Due /49!� _.,
Recei LL-:5
APPLICATION APPROVAL
This application Is not a permit until signed by the
d)v§"clall or hisfiter Deputy: and Fees are paid, and
( rj§celpt Is acknowl0god In space PrVded.
BY
IT 19 14NLAWFUL TO/OSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 41114=4z, W4"L zx
6AAL INSPECTIft HAS BEEN MADE AND APPROVAL OR A CERTIFI- 'O;IGINAL-FI'LE YELLOW-INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
Z.,
FINAL PROJECT APPROVAL FORM
v
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FPT4 PROJECT APPROVAL
Date siim
ocaprvi.doc.l:tcmp:bldg:formsIO/OI
z
9
0
m
:q 9
5-74
OM
c
mo
0
0
c
�m
m
mz
0 -n
n
m M
a V5
0
o Fn
C cl)
c c/)
M 0
Z
z
0)
z
9
0
m
I
DATE
I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
<
MAILING ADDRESS
ZIP TELEPHONE
ADDRESS
CITY ZIP
NAME
ADDRESS
CBL N
1 PERMIT EXPIRES _—�Af
USE —PERMIT
ZONE Eg 11 5 N U M B E Ft�'.
'C?
JOB
ADDRESS �7.
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE5UVWPr0V8d
Rw Permh Required
EXISTING SED
PROPO
Street Use Permit Osqd
inspection Required
Sidewalk Required
REQUIRED DEPICATION
4 - —, FT,
UndeMmund
Wiring required 13
METER S
�JAE SlZe,N,
Nb. OF FjXfURE
PRV REQUIRED
YES [3 NO 13 Z
REMARKS\_
OWNERICONTRACTOR RESP Nsffl�'F EROSION CONTROLIDRAINAGE
CITY ZIP TEIEPHONE
?" 7
,41
STATE LICENSE PIUMBER EXPIRA*rio"yV, I., IIWEC�Ap BY
PROPERTY TAX ACCOUNT PARCEL NO.
C�_ -
( - , 44_11 CL_ � I - C
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
[:Y,REMODEL
MULTIFAMILY
0 REPAIR
[j GRADING CYDS
DEMOLISH
0 TANK
�w
o RETAININGWALL
CGAARRPAOGE
FIT
ROOKERY
(TYPE OF USE, BUISINES1
OR ACTIVITY) EXPLAIN:
.
NUMBER
NUMBER OF
OF
STORIES
DWELLING
UNITS 16
I DESCRIBE WORK TO BE DONE
i
PLUMBING / MECH
El
COMPLIANCE OR
CHANGE OF USE
X
SIGN
[3
FENCE
X FT)
OTHER
F RE SPRINKLER
FIRE ALARM
DATEI
ENGINEERING REMEWED BY
FIRE REVIEWED BY DATE
1-6
VARIANCE OR CU
SHORELINEORADBN
INSPECTION
t5UNU
I
EO'D
I
I
POSTED
s ONO
V
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE
EXEMPT
ALLOWED
PROPOS ED
4LOWED
POSED
PRO6,
, X
/00
19. �
:XP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
A
A
PARKING
LOT AREA
PL"fG REVI, ED
V
ATE
REO'D
I PROVIDED
I
2-q-02-
REMARW pp= M
1= COC 20. GC)
I <z;11 Gw
CHECKED BY jTYP5QDN6TRLrqN C)MEf- ULA; FA..
CRITICAL 10 1 GRO P
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER REQUIRED [3 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REaD
,4 6 VALUATION VVIIIIIII amow
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT 8 LOPE % rmft City Surcharge
PLM CHECK NO:^ o-7 o:;�( VESTED DATE I Plumbing —tj�j I �7T2
Mechanical
THIS PERMIT AUTHORrZE6 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTV ONLX ANV CONSTRUCTION ON THE PUBLIC Grading
DOMAIN ICURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 180DAYS
PERMIT UMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE 13ACK 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
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
NOR LIMIT W ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HEREBY ACKNOWLEDGE THATJ HAVE READ THIS APPLICATION; THAT THE INFORMATION APPUCATIO14 APPROVAL
GIVEN 18 CORnECr 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 until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED B Ildingpfficial or his/her Deputy: and Foes are paid, and
IN VIOLATION OF THE LABOR COOE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIC 0colpt Is acknowlydged n space provided.
WORKME" COMPENSATION INSJIIIANCE AND RCW 18.27.
F 1�11 IGNATURE 0— DATE
P Z -71
(OWNER OqQArE DATE SIGNED IA05)
-0220 R,11�0 D BY
B"IT 771 DATE
A N N EXT 1333,
I L
T 0 X4)2:� f
IT NLAWF SE OR OCC P� A BUILDING OR STRUCTURE UNTIL f - f
L S U ZNU S B ORIGINAL - FILE - YEI I OW - INSPECT04
A A IN PECTI HA EEN MADE AND APPROVAL OR A CERTIFI-
C 0 OCCU y S 8 T OWNER - GOLD - ASSESSOR
PTE F PTAO HA EENUGRAN ED UBC SECTION 109 PINK GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
k
5�
z
0
0
M
M
M
C)
0 C
M
rn
0 In
n
ITIM
0
0
C
K 031
0
V)
z
0
IT!