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DATE RECEIVED Lql
116:
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINE
G 7/1w/t 6
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
517-C J
ADDRESS
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1ITY ZIP ELEPHONE
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NAME L#
ADDRESS
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CITY ZIP TELEPHONE
P�udchdfe 114:17K 3 6 0 --fi�(—A 74—
STATE LICENSE NUMBER EXPIRATION DATE I CUECKED BY
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NEW
RESIDENTIAL
UMBIN ) MECH
Wd FLIANCE
03"'ADDITION
COMMERCIAL
PLIANC OR
0 CHANGE OF USE
011REMODEL
MULTIFAMILY
SIGN
REPAIR
FENCE
CYDS 0 ( _X_FT)
0 D OLISH
TANK [3 OTHER
rGaARAGE
0 RETAININGWALL FIRE SPRINKLER
CARPORT
ROCKERY FIRE ALARM
UWE OF USE, BUSINESS OR ACTINTM EXPLAIN:
",Wc,f rAAlLy ga"&j p7ZIV.4-it
NUMBER
OF
STORIES
NUMBER dIF
DWELLING
UNITS I
CRITICAW
AREAS
NUM4���
DESCRIBE WORK TO BE DONE
0 ir C, cw,&J�1,0 19 ao?f jer,170 Z4 IV I Ar 6 Akc-A
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I GLAZING
PLAN CHECK
1 -7 0%
VESTED DATE
'7 f1
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS wonK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT UMrr I YEAR - PROVIDED WORK IS STAITTED WITHIN 180 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
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 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSAPON INSURANCE AND RCW 18.27.
SI (OWNER AGENT) DATE SIOED/
1 911 / All L,
ATTENTION
PERMIT EXPIRES
USE PERMIT
ZONE
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NUMBER L
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JOB
SUITE/APT#
ADDRESS P/L_
PLAT NAME/SUBDiVISION NO.
LOT NO.,&ekb
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Perm" Required
street Use Permit Req�d
EXISTING — PROPOSED
inspection Required
Sid&*&* Required
D FT
REQUIRE DEDICATION
underground
Wiring required
METER SIZE
LINE SIZE
1
NO, OF FIXTURES
PRV REQUIRED
13 W
9.
Yas NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
BY
GWA
FIRE REVIEWED BY DATE
I
VARIANCE OR CUI
SHORELINE OR ADSV
INSPECTION
BOND
REO'D
POSTED
I
13YE§ GNO
$
SEPA REVIEW.
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
PROPOS
ALLOWED ED
,
0
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EXP
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REQUIRED SETBACKS (FT.)
;PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
2. 29
PA RK G
13OVIDED
LOT A REA
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PLANNING REVIEWED BY DATE 06
REQ`D
1 3
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CHECKED BY UCTION OCCUPANT
I TyAr6ant I CN-7 I GROUP
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S -1ALINSPEcTiON AREA LQj,-)eI2L '6WO ICCUPANIT
PEC I . LOAD
of?p,:52�1 4C�10
REQUIRED [3 YES A ?" ELI
REMARKS
PROGRESS INSPECTIONS PER UBC 100/FINAL INSPECTION REG'D
Description
Plan Check , -
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
de&6�g /Vo.
FEE Description
State Surcharge
,j7W I City Surcharge
1 -4) f% — 1 117 /1 _x --
WWI
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt III
14a" ive4w
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 roes are paid, and
FOR INSPECTION
receipt Is acknowledged In space I provided.
OFFICIALS SIGNATURE DATE
(425)
771-0220
EXT 1333
DAT E
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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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ALL EXPOSED SURFACES TO JAN 2 12:"V3
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erenced permit application
The purpose of this letter is to inform you that the above ref
will expire on March 20, 2003. According to Edmonds Community Development Code
Chapter 19.00.010D, applications are only valid for a period of 180 days unless a written
request for extension is submitted to the Building Official. If an application extension is
or a total period of one year.
or an ad ditional 180 days f
anted it may only be extended f
gr
If you need an extension on the subject permit application you must submit a request in
writing to the Building Official prior to plan review expiration.
Please be advised, once the permit application expires, the application materials and plans
will be destroyed within ten working days. Also, if the project is pursued in the future a
. new permit application and new fees will be required.
If you have any questions, please feel free to call our offices at 425-771-0220.
Sincerely,
'-&Aorns *n&jot/
Permit Coordinator
L\TemP\DST's\Mast.-r Lettem\App Due to Wim 10/21/00
Incorporated August 11, 1890
Sir
for r1hr - Hpicinan Janan
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to
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION'
OWNER NAMENME OF BVSINESS1 .7-
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MAILING A;DRFSS
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CITY ZIPL"__.�T ELEPHONE
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NAME f
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CITY ZIP ITELEPHONE
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NAME
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AlYDRESS
CITY ZIP TELEPHONE 71\
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STATE LICENSE NUM13ER EXPIRATION DATE ECKEI
_nA1L0WW9:`V �'_VJW&:? As
By
mUrr_nlT I W.
[3. RESIDENTIAL UMBIN MECH
C
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F, M'ADDITION [3, COMMERCIAL .0 CHANGE OF USE
EieREMODi , L muLTIFAmiLy SIGN
FENCE
GRADING - CYDS X
.0 RE PAIR 4 FT)
0 R;MOLISH TANK
0 OTHER
RETAJNIf4GWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
UWE OF USE,. BUSINESS OR ACTIVITYI EXPIUMN'.
y - wile Aj1P[:?y(C-
�Wvf -4 P711 V
NUMBER.. NUMBER 01F CRITICAY
-�OF DWELLING AREAS !V_11)V8;r40-
UNITS NUMBk11A0,,q_l "202
STORIES
'DESCRIBE WORK TO BE DONE
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GLA23NG W'-' E%
PLAN CHECK VESTED DATEr,..
NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUS L
DOMAIN (CURBS, SIDEWALKS, 0111111VIEWAYS, MARQUEES. ETC.) WILL REQU
PERMIT EXPIRES _S��
USE PERMIT
ZONE lOfL�o NUMBER(_-,�<*V3,-i��/97\�/
JOB 1%_
SUITE/AFr#
ADDRESS I q 0 y 17m6,L4x_ Q1_
PLAT NAME/SUBDIVISION NO.
LOT No.,19eleb
LID NO.
-LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAE-
rw":.P..
Street Use Pennit 'd
EXISTING 'PROPOSED—
Inspection ReciWed
Sidewalk RaWked
REQUIRED DEDICATION FT
Underomund
WWgisquired
METER SIZE
LINE SIZE,
I NO. OF FIXTURES
PAV REQUIREDj
YES13 NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY/
'if-S
FIRE REVIEWED BY
Nil01
I
VARIANCE OR CUI
SHORELINE OR ADBN
INSPECTION
BOND
REQ'D
POSTED�
13YES Oro
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
'XP
,
LOT.COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED'SETBACkS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
-7.1
1_5 'Xc 7,5'1
2.5 '0/4
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REC`D PROVIDED
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REMARKS.
_11911shb, , ,
CHECKED BY J=UCTION CODE OCCUPANT
! 1 -7 GROUP
SPECIAL INSPECTICK AREA. CCUPANT
I LOAD
REQUIRED L,
13 YES '10
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION RE00
VALUATION -ilwi e
$ lzfza I
Description FEE Description. FEE
Plan Check State Surcharge
City Surcharge
Building Perr*—
Plurpblng
Mechanical
Aradinn
SEPA, RAIr
k: , E PEFkMlqSION.-
2. Review j
PERMIT AP�6'11110fkllil)l DAYS
PERmrr umm I YEAR - PROVIDED WORK IS STARTED WnrHIN loo DAYS ngr. I?Npedon
SEE "�K OF PINK PERMIT FOR MORE INFORMATION
oil's
'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
he6blpt
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire.inspection
#
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
I
" 'An
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
VISION
1�10R.LIMIT;N ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIM.
Recording Fee
Receipt #
RMAT,ON
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE 140RMATION
APPMATION
APPROVAL
13ENT OF
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
NS U C
THE OWNER. Ij#,GREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until sloned by the
4PLOYE
TION. AND IN GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TI To
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees we paid, and
receipt Is acknowledged in space provided.
i WORKMEN'S CQMPEN�BATN INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
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771-0220
RE &tY DATE
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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 YELL&2-IN PECt.,...
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSERSOR
I GREEN - ACCOUNTING
IA/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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