20030274.pdf,0� I i A
DATE RECEIVED 1 1
ZSLI e!� [PERMIT EXPIRES
USE PERMIT
CITVOF EDMONDS ZONE NUMBER&O3 - 0 Z-7
C CONSTRUCTION PERMIT APPLICATION JOB SLIT 1 0
ADDRESS 2 7C
OWNER NAMEiNAME OF BUSINESS
E
PLAT NAME/SUBDIVI SION NO. T NO. LID NO.
ILI
UMMI PMAILINGADDRESS
i LID FEE $
4C PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Approved
NO/3i;10 HO'LS-f-w-
0 "u"Id
"W PI'm Z
Slre@IUI:P r1flReqd 00
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required 0
Sdowalk Required 0
REQUIRED DEDICATION— FT Underground
Wiring required 0
NAME' METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
4�411,kitt( vcc�pl _q�ymv YES 0 NO 0 9
ADDRESS V REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
or
9
CITY ZIP ELEPHONE
NAME
Cal#
ENGINEERING REVIEWEDIDATE
ADDRESS
LJ44A*5(A)
FIRE REVIEWED BY DATE w
CITY ZIP TELEPHONE m
0 77 -5--q 4 0 0
14
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BON
STATE LiCENSE NUMBER EXPIRATION DATE I
REO'D POSTED
(:3 YE!
A�\] t-ss 4 0 e? 7t I
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE I EXEMPT ALLOWED , PROPOSED,, ALLOWED , PROPOSED
00
EXP
C] NEW LOT COVERAGE REQUIRED SETBACKS (FT.) ED SETBACKS (FT.)
RESIDENTIAL PLUM13ING mEcH ALLOWED PROPOSED FRONT SIDE REAR L/R SIDE REAR
ADDITION COMMERCIAL o COMPLIANCE OR z
CHANGE OF USE z
I LOT AREA REVIEWED BY
PARKING DUE 5
;eREMODEL APARTMENT SIGN REO'D I PROVIDED 0.
0 REPAIR GRADING FENCE
CYDS 13 ( — X FT) EMA KS
— OTHER
0 DEMOLISH C3 TANK 0
GARAGE 0 RETAINING WALL
z CARPORT ROCK IY 0 RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
OWJ &1�7 CHECKED BY T VSTRUCTION Cn2E OCCUPANT
GROUP
ul NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTOR JAREA OCCUPANT
UNITS LOAD _719f f__
0 STORIES #�S* I NUMBER REQUIRED (3 YES
DESCRIBE WORK TO BE DONE
UT) M39:9 1I4A_U,.1w4q REMARKS
PROGRESS INSPECTIONS PER UIBC 108/FINAL INSPE z
CTION REO'D
-ro &avj Fv)e- P16rR/ 6N7721y
Q C- OA LS & 1.) SU� L ItT 6W
Wk-L-
VALUATION
FEE
PLAN CHECK FEE:,
HEAT SOURCE NG % LOT SLOPE %
BUILDING
r7on
(212
PLAN CHECK N VESTED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES 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 GRADINGIFILL
SEPARATE PERMISSION.
STATE SURCHARGE/t,
Uj PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS IEW FE S
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ZWrN4(WtN FEE
CAI
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
m INSPECTION FEE
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY TIPT
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
j
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
RE(;9f I
TOTAL AMOUNT DUE ";PK i
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 APPLICATION APPROVAL
7-
ui
a. I
1 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foes 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.
SIGNAT DATE SIGNED (425) OFFIPIALS SIGNATURE DATE
1-3(-0% 2:20 �*"L)
771-0 RELEAS DATE
A17ENTION EXT 1333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN'AL ILE YELLOG - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PIN 4N)E GOLD -ASSESSOR
5/98
I
z
0
m
=i :H
m
mo
0
a -10
c
4c
MM
mz
0 -n
n
..j
3:
m M
0
0
o
C
M 0
Z
X
-4
z
-4
3:
55
z
9
0
m
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
ocaprvLdoc.l:t=V.bldg:foz=10/01
ASS,
1 )-v Al art!
0
Fit., (Ala
DATE RECEIVED
- J/[PERMIT
EXPIRES
P q4
CITV7F �EDMONDS
USE
ZONE
)Y61-
PERMIT
NUMBER&G-OZA
CONSTRUCTION PERMIT APPLICATION
JOB
SU T PTN
ADDRESS 10
2CP07� 70
OWNER NAME/NAME OF BUSINESS
&49496-c
PLAT NAME/SUBDIVISION
NO. LOT NO.
LID NO.
w MAILING ADDRESS
Sw
PUBLIC RIGHT OF WAY PER OFF161AL STREET MAP
LID FEE $
TESCIApp..d 0
0
RW Permit Required ."(3
,
v
CITY ZIP TELEPHONE
EXISTING
PROP OS'E 6
s1reet tide Permit Req'd 0
Inspection ReqUirfid f (3
SHewalk Reqlulredr— 0
�zs"-M-WT
REQUIRED DEDICATION— FT
I underground
mring required 0
NAME'
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 C3
3
4K
NO
ADDRESS v v
44-1
Aw L0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
0
103
CITY ZIP ELEPHONE
U r
eW 670, & 70 (o
q25
NAME Cad
WA�.S — 56 Wkbt
cc ADDRESS
12
0 ;z- — Ito LA 'HA5f- 5 UJ
CITY ZIP TELEPHONE
8 L�VVAVJ"& fto:5( "7-7 5-f Li 0 0
,, 142s7
STATE LICENSE NUMBER EXPIRATION DATE ECKED
P L! I —
Wc -\/ k-S5 4 0 10 Qa YEE.
g PROPERTY TAX ACCOUNT PARCEL NO. 490q I LIF- 001 -01-7 -00
'9 0qSqg-ooZ-00T-0j 0o
00 1z ye-60 L - 010 - 00 0
0 NEW 0 RESIDENTIAL PLUMBING / MECH
ADDITION bf-COMMERCIAL COMPLIANCE OR
0 CHANGE OF USE
>rREMODEL C:] APARTMENT SIGN
REPAIR 0 GRADING 0 FENCE X
CYDS FT)
0 DEM ;OLISH 0 TANK C3 OTHER
- GARAGE WA
0 RETAINING LL
0 0 CARPORT a CKERY 0 RENEWAL
r- (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Pp� F.
NUMBER NUMBER OF CRITICAL
DWELLING AREAS
OF 1�
o STORIES, - UNITS NUMBER
DESCRIBE WORK T0'11E-DONE
-ro 41," W FOL 06 W 6IV7YZ-V TO—
D� M LS C- 13 5UtTrn , N&W OWSW6-
W r -':�) I L 1614 1'
JA (To MjkV
a6t,,OCATION�
ENGINEERING
REVIEWED/DATE
1
z
. IL: ..
0
0
m
FIRE REVIEWED BY DATE
c3
UJI
m
6:1
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
RECI'D
C ES
3 Y
BOND
POSTED
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED R OSED
OP
XP
55
M
m 0
0
0 C
5� r.
Ph
M,
10
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT LJR SIDE REAR
PARKING
REO'D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
z
0 -1111
CHECKED B Y
TYP ST UCTIQN
P S� UCTI N
CQP OCCUPANT
r
GROUP
"EA
m m
IR
'SPECIAL, INSPECT R
REQUIRI
AREA OCCUPANT
A
LOAD
0 Fn
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
C=
11. U, I V
VALUATION
FEE
PLAN CHECK FEE
z
0
HEAT SOURCE
GLAZING %
I
LOT SLOPE %
BUILDING
ot
eklT
-4
0
PLAN CHECK N
VESTED DATE
PLUMBING
m
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
GRADING/FILL
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAiN (CURBS, SIDEWALKS, DRIVEWAYS, MAROUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE//It,
. --I
A.0
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
IEW FEIS
N N FEE
50
'APPLICANT, ON BEHALF OF HIS OR HER S�DUSE, HEIRS, ASSIGNS AND SUCCESORS
2
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
DEEMEDTOMODIFY. WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT . �
RECEIPT " 4.,
4�4—
f
0
NO011MITINANYWAYTHECI 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
m ma%lcyl
TOTAL AMOUNT DUE 1/471
199 1 &15— :1� / /) ar
I 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 APPLICATION APPROVAL
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This applicallonis not a perrnit until signed by the
D , - CALLr Bull I or'hWhor 0eputy: and Foos are paid; and
TION;ANDIN DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED ding Offlcja
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In spaock provided.
HE'
V
[G E
T I
HE
TION
IN VI
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFMIALS SIGNATURE DATE'
S SIG
IGNATI NER 0 AGENT� DATE SIGNED (425)
771 -0220, - R
ELEAS D DATIE
A17ENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- t,
ORIGINAL ILE) YELLA - INS'PECTOR x
L
E
CATE (IF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - 4NE GOLD - ASSESSOR
5/98
..........