20030231.pdfI
DATE REC!Z 25i 1()5 PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB RESS I SUITE/APT#
PR NAMEfl*ME OF BUSINESS 7 7 7_ , I ADD q91, Sr
I.- e,- /,o 611* ",
MAILING ADDRESS
41�� �, e!41�1�9 J
CITY I e ZIP ITELEPHONE
, 11,j
e!!�C_4 r -2
NAME
ADDRESS
CITY ZIP ITELEPHONE
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPFDV*d
RW Permit Required
Street Use Permit Rrqd
EXISTING PROPI
Inspection Required
SidewalkRequired 14
REQUIRED DEDICATION Fr
Und6rWound
Wiring required [3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED 93
13
YES NO
I
REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CAI k ANAA-
IWS�W
2!vg L#
ADDRESS
2, to
TELEPHONE
72r-2e-1c-
STATE LICENSE NUMBER EXPIRAT57IODATE HECKED BY,.
PROPERTY TAX ACCOUNT PARCEL NO
KNEW
RESIDENTIAL PLUMBING / MECH
COMPLIANCE OR
1:1 ADDITION )<COMMERCIAL GE OF USE
[� �SIGN
E] REMODEL
MULTIFAMILY
REPAIR
L_ Ei FENCE
GRADING CYDS ( _ X_FT)
DEMOLISH TANK
0 OTHER
oGARAGE RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINES
LZ %-AL.,"
NUMBER
NUMBER OF
CRITICAL
OF
OWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WIRK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: zi 7 _/1 (7 1 1 VESTED DATE
THIS PERMIT AuTHonizEs ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK 15 STARTED WITHIN 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 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 M 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
WORKMEN'S COMPENSATION INSURANCE AND RCW 118.27.
BY DATE
� Il— �311
FIRE REVIEWED BY DATE
VARIANCE OR CU J�S INSPECTION BOND
j AEO'D POSTED
r5&s 13NO 1$
SEPA REVIEW SIGN AREA 04' HEIGHT
COMPLETE T ALLOWED , PROPOSED I ALLOVED PROPOSED
:XP I :R I N 14 10 14 ? —
LOT COVERAGE REQUIRED SETBACKS (Fr.) - _pROPOSE61ETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
PARKING LOT AREA LANNING REVIEWED BY DAT
REO`D I PROVIDED 11P
CHECKED BY ITYPE OM YOW I %'
GRO
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES IOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION RECIV
VALUATION
$ I —
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
AM
Description
FEE
State Surcharge
City Surcharge
t>1
L2
Fire Review
Plan Chk. Deposit
LOU —
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
ZLM
Recording Fee
Receipt #
APPLICAI - - IROVAL
CALL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged In space provided.
O3FW ATURE - 0 *E
(425)
.61 t37
/ �WA& 4&, A-, 7�2
771-0220
RELEASEM-RY�;, 'DATE
EXT 1333
�� Of
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- nRIGINA 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 .... .... ,
I
z
M
M
M
80
M
o
z
0
Irn M
5;
CO)
CO.
M 0
Z
z
0
4
0
M
z
0
1
0
M
=i --fi
vj 4
am
a
MO
0
-40
0 C:
-4 C
X M
M4
to
z
co
0 In
"n
mm
065
0 r-
0 M
C cl)
c CO)
M 0
Z
M
z
-1
M
ro
z
0
1
F)
m
FINAL PROJECT APPROVAL FORM
c
z
m
M
rn
0
80
c
� c
m m
ct?
0 -n
n
m m
065
0 r-
0 rn
C co
c c4
M 0
Z
.4
M
z
z
9
0
m
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Si
Date___----.
ocaprvl.doc.I:WM:bldg:fomasIO/OI
1. 7 . '. -77'�,7 7 :,
I
7 71
DATE RECE!,Y_
7.0�
[PERMIT EX PIRES In I z 1 U7?
CITY OF EDMONDS
USE PERMIT 0
ZONE
4�
NUMBER -5---
CONSTRUCTION PERMIT APPLICATION
JOB sunVAPT#
ADDRESS qory,
7 NA,M E OF USINM
PLAT NAMFJSUBDIVISION NO. LOT NO. LID NO.
-�-d ; e- /4
MAILING ADDRESS
LID FEE S
7E5GF APPMV*d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerrrJt 119"Ired
CITY P TELEPHONE
C/lj---
I---- street Use Permk RWd
EXISTING =—PROPOSED InspecUon Rsqum
Slow"& ftquM
UndwWmM
h42,
74'
REQUIRED DEDICATION FT WWU roquked FJ
NAME
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED 0
13 4io 13 3
I
YES
ADDRESS
REMARKS I
OWNER/,CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAIIVGE_
CITY Zip TELEPHONE
CALL f!29 AWL T*161weOWIlat IWWTION..
I
A ENGINEERING REVIEWED BY PrT 4 LAVWAZ -PfVTLF.DA-fE
W
ADDRESS
11
FIRE REVIEWED BY DATE
TE LEPHONE
-: 72,r, 2e, A
VARIANCE OR Cu RELINE 0 INSPECTION BOND
N
o-CHECK D
STW LICENSE NUMBER EXPIRATIO1 DATE,,-r 'E I IJ AEO'D POSTED
F'.5, e 4r,; e'p 0"I C, 0i Pj Vs 13NO $
Q0.1600
llrv��
SEPA REVIEW SIGN A5AEA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. 1, _COMPLETE T ALLOWED PROPOSED ALLOVED PROPOST
:EXWEM
t t4M6
1. 15kl 141q Iq
. EXP M -U,�)
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED 1;ETBACKS (FT.)
4EW RESIDENTIAL PLUMM04UECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
X
COMPLIANCE OR
ADDITION MMERC.IAL 13 GEOFUSE
)CCO,
Jq1
PARKING LOT AREA 1,PLANNING REVIEWED BY DA]
REMODEL MULTIFAMILY CIGN REO'D I PROVIDED
REPAIR GRADING FENCE
CYDS x FT) REMARKS
J%
DEMOLISH TANK OTHER
oGARAGE RETAJNINGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
MPE OF USE, BUSINE
,6n7,m
CHECKED BY OF OCCUPA
GROUIZ.
NUMBER NUMBER OF CRITICAL CTION jAXRE
OF DWELLING AREAS SPECIAL INSPE OCCUPANT
—STORIE UN;TS NUMBER REQUIRED 0 YES LOAD
n;:SC TO BE DONE REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION RE=
:z
/Z/ IN
Description
FEE
DescrlpUon
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CklPCK NO: VESTED DATE
Plumbing
A
Mechanical
THIS PIERMrf AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
k: 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
1#1h
2 DOMAIN (CURM GIDEWAM. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
9
Engr. Review
I PERMIT APPLICATION: �W DAYS
LIMM. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
A
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
;APPUCANT,
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, IfS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTIYOR 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 UL41T IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION API IR L
GIVEN IS CORRECT� 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 unlit signed by the
TION. AND IN DOING THE WORKAUTfIORLZkD THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy! and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowiedged in space provided.
WORKMEN'S COMPENSATION I�SURANCE AND RCW 18.27.
OF ATURE D�TE
Amia—T—LINVON—ER GEtM:k DATEAGNEV
1425)
9/7/10
771-0220
RELE DATET--7
ff—E N T 10' N
EXT 1333
7V W-,7.
161
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
CKfE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING
--------- —