20030232.pdfI
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
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MAILING ADDRESS f4j)AR1.4 Piffh V-aAt- S$TA-M_ N.
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CITY ZIP VLEPHONE
ADDRESS
CITY ZIP
PERMITEXPIRES
USE PERMIT
ZONE tj U NUMBER
JOB SUITF/APT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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asmil
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LID FEE $
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP Approved
RW Permit Requked
Street Use Permit 'W'.
EXISTING - PROPOSED
inspection Required
Sidewalk Requlr*d
REQUIRED DEDICATION- FT
Underground
Wiringrequired 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES 13 NO E3 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
NAME
CBL#
��_TAIEE
ENGINEERING REVIEWED BY
DATE
ADDRESS
Box
33-3-70
FIRE REVIEWED BY
DATE
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CITY
ZIP ELEPHONE
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5'06:11M
C7 020
VARIANCE OR CU SHORELINE OR ADB# INSPECTION
STATE LICENSE NUMBER
ECKED B
1711202_.. POSTED
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SEPA REVIEW SIGN AREA
. � HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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ALLOWED POSED
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;g.PLUMBI MECH
LOT COVERAGE REQUIRED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR
PROPOSED SETBACKS
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FRONT URSIDE REAR
COMPLIVAN
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0 ADDITION
COMMERCIAL
CHANGE OF USE
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PARKING AREA PLANNING REVIEWED BY DATE 4V
REMODEL
MUI.TIFAMILY
SIGN
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REPAIR
GRADING CYDS
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DEMOLISH
TANK
OTHER
oGARAGE
RETAINING WALL
[3 FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY)i EXPLAIN:
CHECKED BY ITYPE F CONSTRU900 C E
assesses
OCCUPANT
GROUP
14-Ir-1 64�! -.5
_7CRITIGAL
11-11.
NUMBER
OF
NUMBER OF
DWELLING
AREAS
SPECIAL INSPECTION Jr
OCCUPANT
LOAD
STORIES
U
NUMBER
JAREA
REQUIRED
DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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Eaviemebrr LAO, _--licaawazz O-hLy !VALUATION
Dewriptlon FEE Description FEE
Plan Check State Surcharge
I- -
HEAT SOURCE
T6� NG %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO,
Z�2�
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUSUC
Grading
DOMIUN (CURES, SIDEWALKS, DRIVEWAVS, MMOUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
t
Engr. Review
PERMIT APPUCATION: 180 DAYS
M. PERMIT ILIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPUCANT; 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
T
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
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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.-
Recording Fee
Receipt #
1-9
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 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
F I GNAT ATE
S1 URE (OWNER C =AdE
DATE
sr
NED
(A-25)
. wAr- 12...
1--, ) k'
3
771-0220
UAIEf
REL
77TENTION
EXT 1333
_2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILJ 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
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Y*iiMTE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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V(F m!!� P 1? L
MAILINGADDRESS MORRI5. PjjiA iZr-AL C_F74M
RQ. _1250Y 5:73-2_90
CITY ZIP VILEPHONE
1 E ADDRESS
CITY
NAME
1?z C� —
41 ADDRESS
ZIP
CBL N
CITY ZIP ELEPHONE
6IF-A'11, 1� 206 1 9jj3jj —
STATE LICENSE NUMBER EXPIRATION DATE ECKED B
-17)--7 — - — - - — I 4''mij I I
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
[3 muLnFAmwy
REPAIR
GRADING CYDS
DEMOLISH
13 TANK
0 GARAGE
-1 RETAINING WALL
1:3
CARPORT
RocKERY
(TYPE OF USE, BUSINESS OR ACTIVITY'll EXPLAIN:
NUMBER
NUMBER OF
F' IES
0 STOR
DWELLING
UNITS
DESCRIBE WORK TO BE DONE
USE
ZONE
JOB
IF,] PERMIT EXPIRES
PERMIT zay,
NUMBER
-Omz,
SUITE/APT#
-s� 14 '21-2-
PLAT NAME/SUBDIVISION No.
LOT NO.
LID NO.
jAf)Lr-j5
A
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW PefffA Required
Street Use Perrinft Raq'd
EXISTING — PROPOSED
InspoctlonFloquired
Sidewalk Required
REQUIRED DEDICATION—
FT
Underground
WkIrtgrequirad
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES 13 NO [3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAI NAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE I
VARIANCE OR CU SHORELINE OR A111111 I INSPECTION I BOND
A REQD J. POSTED
1 ,,7r OYES jW0 Is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED VqCPOSED
4OV40
EXF �%ajte
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (1`15�
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING if& AREA I PLANNING REVIEWED BY DATE IL
REQ`D I PROVIDED A � :,IV14
II
CHECKED BY ITYPE F CONSTRU610) OCCUPANT
0 - / &6 !!; GROUP
i � I-
ARITICAL him
REAS SPECIAL INSPECTION JAREA �C_CUPANT
MBER "11A REQUIRED [:] YES LOAD
REMARKS
d— PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D
R 00 1�-ryp
PLUMBIN((MECH)
COMPLIANCIT109—
CHANGE OF USE
SIGN
o FENCE
FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
Fayipmem-r LA-T-4. Le_oou N t, p/4 L
VALUAnON
0
$ 7000*
Description
FEE Descripticin 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
I-- BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
3
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT IJIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BE"ALF OF HIS QR . HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire RevIeW:
Plan Chk. Deposit
;APPL'CAN7,1,
N INTeRE T, AGR9ES TO INDEMNIFY. DEFEND AND.HOLD HARMLESS THE,CrTY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR UL41T IN ANY WAY THE CITYS ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN 13 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 application 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
FF1 I I GNAT PATE
DATE
SIGhLATURE (OWNER NED
Sri
1A 0
lk-125)
1%M -v--31),V--1t_2_11
3 >
771-0220
DATE
ATTENTION
EXT 1333
a-f-s
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
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