20030193.pdfDATE RECEIVED
1
PERMIT EXPIRE
1 S319
A7
CITY OF EDMONDS
USE PERMIT o�o 0;�' C1 --27
ZoNj�
NUMBER ��
CONSTRUCTION PERMIT APPLICATION
JOB S
ADDRESS q
Z �)
'zv PYM
OWNER NAMEINAME OF#SINEW
-
'V3 'NO
PLAT NAME/SUBDIVISION NO. LOT NV' L -
MAILING ADDRESS
LID FEE S
;7 A"V_z1V
TESCP AMOVId
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Parrm "W'u1r_
Use Permh R@q'd T
CITY ZIW TELEPHONE
SuM
EXISTING — PROPOSED Inspection Required
Sidewatit Roquk*d
underground
REQUIRED DEDICATION— FT Wiring required
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO 13
I
z
ADDRESS
REMARKS
OWNER/fi"TRACTOR RESPO_kSIBLE FOR #ROSION CONT�ROLJDRAINACAE
1�rm A WA_tLr-d(
CITY ZIP TELEPHONE
I10e4_.1
1 f2
NAME Cal-#
I
D.&4:1ete-e-e�f-
ENGINEERING REVIEWED BY DATE
AUVRE53
'no
CITY ZIP TELEPHONE
FIRE REVIEWED BY DATE
cc
M
q,e ;t 7 1� 5� —qll
On- Tb,rpCGUjg0I gl
R
UIN MSF'EWI
VARIANCE OR CUI EORADB E ION BOND
STATE LICENSE NUMBER EXP WRAON 1p
gVt 0 S ET TO BE CL *&ffWN*BRd OSTED
TR� SHOFIELINB13
17
0 C,
SEPA I IGHT
COMPLETErE PA&CMNA0, PROPOSED
UP, %%Iruf
PROPERTY TAX ACCO
EXP
NEW RESIDENTIAL PLUMBING/MECH
LOT CCftRtA?WWAF 110ft 1,11IMMORBACKS (Fr.)
ALLOWED PROW86t111SMqT"D FIN ;7AVMI)/R SIDE REAR
COMPLIANCE OR
ADDITION p9'2'aOMMERCiAL 0 CHANGE OF USE
D-ILIMIJ Aqr A 2 . I= ON119
z
I
MULnFAMILY SIGN
REMODEL 11
PARKING LOT AREA NIN�RCVI&hED BY DATE
REOD I PROVIII
F)..7,4 01 ITION INSPRICTION
IL
FENCE
REPAIR GRADING CYDS 11 X
11=1 CAurs
REMARKS is i3AcK ar, -
FOR IL 110N 1,
'EQUIREMENTS
IN DEMOLISH 0 TANK b OTHER
oGARAGE RrTAININGWALL FIRE SPRINKLER
13
CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINES
nmwm� PANT
CHECKEDBY VfnE-1 OCCU
GROUP0'_'_
ITYPEOF=16
NUMBER NUMBER OF CRITICALV
OF DWELLING A
8z
SPECIAL INSPECTION OCCUPANT
STORIES UNITS N
IWA
REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REO'D
ell
VALUATION
$
Description
FEE
DescriptIon
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING LOT SLOPE %
%
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCnON ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SFPARATEPERMiSSION.
Engr. Review
PERMIT APPILICATION: 1160DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAK 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
I 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
Landscapeinsp. Total Amt. Due
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
JNOR
Recording Fee j Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVE IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
NWNEFL
THE 0 I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL ;Pis application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Oificial opq1he
Bu r Deputy: and Fees are paid, and
IN VIOLATION OF THE LABgLQODE 0 THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION iick"edged In space provided.
irlIg
WORKMENS COMPENSATPN INSU�ANCE AND RCW 10.27.
OF ICI LS SIGN E ATE
TlR aN'ER ORItEj� DATEAIGNED /
O�LRE
� 0, 1 1/ j -h / /'9 -,;i
(425)
1
ELEASED BY DATE
V
ATTENTION EXr 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
I
rr I.."ll v
1 3
EIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
= S12� tz,
MAILING ADDRESS C7
c�ITYLJO_Z Z1W
100 ;�6 ITELEPHONE J
4 )_ 5_7 71e 15
F: ADDRESS
CITY ZIP TELEPHONE
NAME
PERMIT EXPIRES
USE PERMIT
ZONJ� NUMBER 0?2 _019:3
JOB - Li �uo su
ADDRESS Z
vja,4
PLAT NAME/SUBDIVISION NO. NO.
LID FEE S
L!! I E� Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PenrA Reciulmd
Strom Use Pennit Roo
EXISTING — PROPOSED umpectsonflaqWred
Sidevralk Re"Irsd
urAerground
REQUIRED DEDICATION— FT WWg required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO E3
T
REMARKS
OWNE�/�"TRACTOR RESPOVIBLE FORJfROSION CONTBOL/DRAINA9,E
Lmo wa— L
ENGINEERING REVIEWED BY
DATE
ADDRESS
144 006L
41,?�&aek
Ao�
REVIEWED BY
DATE
z
CITY
ZIP TELEPHONE 1
7,
7
7 4 i� -17// 1
..T�-- T_'
0
-
VARIANS_ Y@WN
BOND
M
STATE LICENSE NUMBER
E�WIE
j REO'D POSTED
0 ST* ET TO BE CL IMIUS
L
2 z-
SEPA WIMP
COMPLETE EX E SRLW1D%ft&&CkPMAT1
HEIGHT
PROPOSED
PROPERTY TAX A=CO
in
:n6o
PROPIRTY LINf
0 M
i.
n i
EXP
C:
M
1:1 NEW
RESIDENTIAL
PLUMBING /MECH
LOT Cam W AT so=-
A RFD%
Ro
ALLOWED PR M BINOW1 N
KS
E
N
0 ADDITION
OMMERCtAL
COMPLIANCE OR
0--tHANGE OF USE
db INV*—
-COMA
17
r;
M
[3 REMODEL
[3 MULTIFAMILY
SIGN
PARKING
REQ`D PROV11Wg N
ON INSPECTION
P
M
10
[3 REPAIR
GRADING
CYDS
FENCE
X_FT)
REMARKS
Ion am
`A�4
DEMOLISH
TANK
% OTHER
FOR INSPECTION REQUIREMENn,
..
0 GARAGE
RETAINING WALL
FIRE SPRINKLER
FIRE At ARM
011.
CARPORT
ROCKERY
C nc j Ise: B"SIKIC
CHECKED By TYPE OF OCCUPANJ_.
GROUP
UCTIF03 505 /f2j
I
Irn M
NUMBER, NUMBER OF
OF,: DWELLING
STORIES UNITS
CRITICAL
AREAS
NUMBERM
SPECIAL INSPECTI OCCUPAN]
ON IWMA LOAD
REQUIRED [] YES
86
0 rn
c
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER ILIBC 108/FINAL INSPECTION RECVD'
em�
2
arms ilk
X
V&UATION
z
$
z
Description
,,c.FEE
Description
FEE
Plan Check
1CItySurcharge
State Surcharge
M
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
I:
2
THIS PERMIT AU7`HOR1ZE6 ONLY THE WORK NOTED. THIS PERMIT covEns WORK TO
BE DOME ON PRIVATE PROPERTY OHLX ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PER ITAPPLICATION. 1e0DAYS
PERNIILIMMIYEAR- OVIDEDYWORKIBUIPWIEDYW1111114 Engr. Inspe ion
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APP ANY; ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
N 19REST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
S. 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 Landscapelnsp. Total Amt. Due to
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY C17Y ORDINANCE
NOR umrr IN ANY WAY THt..cffYs ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt #
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- 140 application Is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL jd� Otm:W qyhrper Deputy: and Fees are plad, and
IN VIOLATION OF THE LABO&LODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt 1qPrk#oyAodgod In space provided.
WORKMERS COMPEN8AT)0WTWS_DTNCE AND RCW 18.27. OF IC LS SIGN R . WfAATE
R , E UAT/EIGNED 142
771-0220 ELEASED BY DATE
ML 7___
A-ftENTION M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL.
A FINAL INSPECTION 1-fAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
GREEN -ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES