20030277.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
— / 716 '401
CITY
ZIP
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NAME
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ADDRESS s'
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ZIP
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NAME
TELEPHONE
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TELEPHONE
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ADDRESS
IvIlb _106 Al
CITY ZIP TELEPHONE
Woo- 1 _3
STATE LICENSE NUMBER EXPIRATION
1_.rheo & I (?q ton IF -:i
PROPERTY TAX ACCOUNT PARCEL NO.
06 LL]
LPERMITEXPIRES
S E
USE PERMIT
N E
ZONE
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NUMBER
3
JOB
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ADDRESS 23 1/0-/-) 20� 1f,
D R
SUITE/APT#
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PLAT NAMEISUBDIVISION NO.
P LA
LOT NO.
LID NO.
I
LID FEE S
U
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P B
TESCP Approved
RW Perffgt Required
Street Use Peffnk Req'd
rXI S
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
R Eal
REQUIRED DEDICATION— FT
underground
Wiringrequirad
13
METER SIZE
LINE SIZE
FZ OF FIXTURES
PRV REQUIRED
1
YES 13 NO 13
5
I
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
b % 6)
r-1 mAL_,
Q51NEW
[3-�RESIDENTIAL
PLUMBINGI MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
0 GRADING
CyDs
01 FEN;,,
t X FT)
DEMOLISH
TANK
0 OTH��y I
Z
oGARAGE
CARPORT
[31 RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
OWE OF USE, BUSINESS OR ACTIVrM EXPLAIN:
NUMBER NUMBER OF RITICAL
OF DWELLING CAREAS
STORIES UNITS 1BER
DESCRIBE WORK TO BE DONE
C'X-' " R�4-e4- -P 4U-r— 't rt
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
X clu
:1 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARGUEFS, ETC.) WILL RE IRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 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 CIAJMS FOR DAMAGES OF WHATEVER MATURE. 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 Awl CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT6 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-
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABgODg E OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSA
__j9ff NSUFfNCE AND RCW 18.27.
S107 (OWNER OkAGE DATE SIGNED
BY
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINEORADB#
I INSPECTION
BOND
L . REQ'D
POSTED
Is
yovEs ONO
BEIRA REVIEW
SIGN AREA'
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALL07ED PROPOSED
,
,
_XP ,
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
BY
DATE
PARKING
REDID PROVIDED I
LOT AREA
I PLANNING REVIEWED
I
k�r�-11-9k.'71131
REMARKS
CHECKED BY ITYPE ONSTRUCTION OCCUPANT
7_77 - GROUP
SPECIAL INSPECTION fAREA OCCUPANT
REQUIRED [[:3] YES LOAD
REMARKS I
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD 1 9
I I PC
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
7 t _0 1 5—
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # L112
lion is not a permit until signed by the
or hlslher Deputy: and Fees are paid, and
rpckngwI,9WIn space provided.
55
ATTMTIOK off 1 33
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L /
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FIF - /YE:0N/iNSP TCTC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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11
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APPROVED BY PLANNING
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MAY 0 5 2002
E)EVELOPMENT -,,eclViCES CTR
cl"y OF EDMOWDS
APPROMMAN EARINWORK QUMn'nfS GRADING AND T.E.S.C. PLAN
4EXCAVAIION: 450:k CUBIC YARDS FOR
FILL : . . 20* CUBIC YARDS UNCOLN ESTA 11E LOT 11
APPROVED AS NOTED
BY ENGINEERING IN NE174 OF SECIION 369T.27 N.,R.3 E.M.M.
CITY OF 'EDMONDS
SNOHOMISH COUNTYa WASHINGTON.
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
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RE-iNsPEcTED oursTANDiNG issuEs - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
01�
SETBACKS ......
...............
FOUNDATION:
Footing............ ........
Wall.........................
Pier/Porch .................
Retaining Wall ............
io
Slab Insulation ..........
r
PLUMBING:
m
Underground ....
Rough -in ...................
...... ..... ....
C.
iiclal Final ......
omm
C Z'.
-�.HEATING:
'Gas,Test.
..................
4: -n
Gas, Piping ...... ............
E Ulornent ...........
Comrnerclai Finaif .......
C:
-EXTERIOR SHEATHING
NAILING ..........................
C)
FRAMING ........................
INSULATION . ...................
FIRST FLOOR FRAMING� ...
Floor Insulation ..........
Wall Insulation ........... Z�
Ceiling Insulation .......
-..SHEETROCKNAiLING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
Fn
FINAL APPROVAL FOR
OCCUPANCY ................
ATE RECEIVEP I
CITY OF EDIVIOWDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Z10 C C11A
MAILING ADDRESS
r
CITY ZIP TELEPHONE
e,, , 7' 1
/ 141A - f&;c -I' V?5-
NAME
,.0 _<
ADDRESS
31TY ZIP TELEPHONE
ril V -, k- # ?A6-<37_C
NAME ICBLN
4j(&=jL,A &C Y-J4
ADDR
/19/16 _100 Al :5�
CITY ZIP
STATE LICENSE NUMBER
Zrneoc_
PROPERTY TAX ACCOUNT PARCEL NO.
21 0 SL
TELEPHONE
4/75"� 3
q- /T- 0
[&NEW
[3-RESIDENTIAL
0 ADDITION
COMMERCIAL
1:1 REMODEL
0 muLnFAmiLy
0 REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAININGWALL
ROCKERY
OWE OF USE. BUTLINESS OR ACTINTM EXPLAIN:
NUMBER
NUMBEROF.
OF.
6��s
DWELLING
UNITS
DESCRIBE WORK TO BE DONE
"A �f k e
2
PERMITEXPIRES
USE PERMIT
ZONE
Fz_
NUMBER
2
JOB
ADDRESS 4L A441
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL Sr EET MAP
TESCP Approv9d
AW PenmN Required
Street Use Parmil Rocfd
EXISTING — PROPOSED
inspecUon Required
Sidewalk Required
REQUIRED DEDICATION
tlnder�
Wking required
METER SIZE
LINE SIZE
NO. OF FIXTURES
RV REQUIRED
YEB 13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
I ocwwtioos. Fi5m) f=71 MAL-0
%4-.V 1 ICA. V %.0Lj%_0
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINEORADON I INSPECTION BOND
L �, REO'D POSTED
15yEs 13NO IS
SEPA REVIEW SIGN AREA' HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALL07ED j PROPOSED
__XP 5'ass 1
LOT COVERAGE
REQUIRED SETBACKS ( ) PROPOSED SETBACKS ( )
PLUM13ING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LIRSIDE REAR.
I
COMPLIANCE OR
z
CHANGE OF USE
PARKING
LOT AREA PLANNING REVIEWED BY DATE
SIGN
RECID PROVIDED
I
I
I
I
4t241r7--- Af-1/03
o FENCE
( do' X FT)
REMARKS
OTI-Igly I y
F RE SPRINKLER
FIRE ALARM
CHECKED BY ITYPE ONSTRUCTION
CRITICAL
AREAS SPECIAL INSPECTION AREA
NUMBE.OVI 3
REQUIRED [:] YES
A IEMARKS
,"J�R;)63RESS INSPECTIONS PER UBC
Description
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE
L W
Plumbing
Mechanical
TMS PERMIT AUTHORMFS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
a
Grading
-6, ETC.) WILL n
M DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEE EQUIRE
t: SEPARATE PERMISSION.
Engr. Review
PFRMITAPPLICATION: 180 DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN,INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CirirS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT fHE 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-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOB!CME OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMENS COMPENSAff �IN F+NCE AND RCW 18.27.
JA
FEE
OCCUPANTV.g
GROUP
0- %,wor
OCCUPANT
LOAD
INSPECTION REa�'D!j
Description FEE
State Surcharge
City Surcharge 115—
Plan Chk. Deposit
Receipt #
Total Arnt. Due' `L
Receipt # P I
tion Is not a permit until signed by the
or his/her Deputy: and Fees are paid, and
rlackqmWeW In space provided. I ..L,
SIGI�� (OWNER OkAGE DATE SIGNED 70 0)
42 3 771-0920
RE 15A�VU E
ATTL*TI'OW EXT 13:33
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR�GINAL-Fft -)YELLOW/1N SWCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P NK - OWNS4--"- GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
I L.