20030303.pdf11
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILI:M �V_Whu /7'
cl ZIP TELEPHONE
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NAME A
ADDRESS
CITY
TELEPHONE
NAME Cal. Nf
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ADDRESS
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STATE LICENSE N JMBER EXPIR"ION DATE CH
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PROPERTY TAX ACCOUNT. PARCEL NO.
NEW
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RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
A,
0 MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
FIETAININGWALL
ROCKERY
(TYPEM USE, BUSINESS OR ACT
4UMbER
OF
STORIES
d
NUMBER dF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE
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PERMIT EXPIRES
USE PERMIT
ZONE
AV2
NUMBER
JOB SUITE/APT#
ADDRESS 7'
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Apwovod
RW 'rr. ".i'ed
Streld Use Permh Req'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— Fr
Underground
[3
METER SIZE
LINE SIZE
0, OF FIXTURES
PRV REQUIRED
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REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
119
REVIEWED BY DATE
FIRE REVIEWED BY DATE us
VARIANCE OR CLI SHORELINE OR ADBI I INSPECTION 1$ BOND
REO'D POSTED
SEPA REVIEW I T— SIGN AREA Dvzs 13NO HEIGHT
COMPLETE . EXEMPT I ALLOWED . PROPOSF�l I
, ALLOWED . PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
PLUMBINGIMECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR
CHANGE OF USE I I—— . _ I
PARKING AhIVZ fIfijVIWA**WED BY DATE
1 1.071 06
Lj SIGN REO'D I PRC
FENCE
( _X Fr) REMARKS
OTHER
F RE SPRINKLER
FIRE ALARM
BEIPRESENT FOR
CHECKED BY ITYP
CRITICAL
AREAS SPECIAL INSPECTION AREA
REQUIRED 0 YES
NUMBER Nfir—
REMARKS
PROGRESS INSPECTIONS PER UBC I
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HEAT SOURCE T GLAZING % LOT SLOPE %
PLAN C—HECK NO: VESTED DATE
THIS PERMIT AUT14ORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSYRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMrFAPPILICATION: 160DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 DAYS
SEE 13ACK 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 CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTvt
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 13 CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP-.Y 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 =!:�MURANCE AND RCW` 18.27.
SIGNATWe��WNEFI )DR(AGENT)
DATE SISNED
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CODE OCCUPANT
GROUP /,
OCCUPANT
LOAD
I
INSPECTION REO'D
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
/5
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
I 4?2z
L
CALL
FOR INSPECTION
IA95)
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771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official of Mother Deputy: and Foes are paid, and
receipt Is acknowledged In space provided.
OFFICIALS SIGNATyfi E D�TE
/" LdAg_
RELEASED BY L_/ / 'DAT7
ATTENTION Off 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
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign,
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CF
IbATE RE ivEQ, U K,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O11N=SINESS
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MAILING;rR
ITELEPHONE 721 W2 L
NAME
ADDRESS
CITY
TELEPHONE
NAME F, I CBL N
ADDRESS
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CITY ZIP TELEPHONE
ITI e E/0- 1A
STATE LICENSE NUMBER C)R EXPI ION DATE C
FILCOCI oe:F_�� I M-Y
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PROPERTY TAX A99,01UNT
'7
[3 NEW
11""RESIDENTLAL
1:1 PLUMBING / MECH
ADDITION
COMMERCIAL
[3 COMPLIANCE OR
CHANGE OF USE
REMODEL
0 muLnFAmiLy
1:1 SIGN
REPAIR
GRADING CYDS
FENCE X
( FT)
DEMOLISH
XTANK
—
[3 OTHER
oGARAGE
[:3 RETAININGWALL
FIRE SPRINKLER
CARPO
ROCKERY
FIRE ALARM
(TYPE BE. BUSINESS OR ACTIVTM k
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NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE
DONE
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USE PERMIT
ZONE NUMBER "a z&a3'I
JOB SUITE/APT#
ADDRESS e�L owmITts�,7'
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Perm" Rewired
Street Use Perm" Roo
EXISTING — PROPOSED inspection R*qL*W
Sidewalk ReWhO
REQUIRED DEnICATION— FT Underwound
WWgrequired
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NOD
REMARKS
OWNER/CONTRACTIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING Rffl1WYM&EU.-. A W'"A I 1r__1 0 1 11 DATE
FIRE REVIEWEDWV DATE
VARIANCE OR CU SHORELINEORADIM I INSPECTION I BOND
REO'D POSTED
13YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SET13ACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
I I
PARKING LOT "LD BY DATE
RECID I PROVIDED
UST BP PRESENT FOR
REMARKS IA K P111 I 0CkAr%%fAI ^13 f% A n
CHECKED BY
ITYPE 0;F.JONSTR
ION
CODE I
OCCUPANT
GROUP
SPECIAL INSPECTION
OCCUPANT
ILOAD
REQUIRED [3 YE
JAREA
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION RE D
VALUAnON
Description FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHOR12ES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
Description
State Surcharge
City Surcharge
7. 7' --z . .7—
Ehgir. "few'
PERMITAPPLICATION: 180DAYS
PERMIT LIMIr I YEAR - PROVIDED WORK Ifil STARTED WITHIN 180 DAYS Engr. Inspeeflon,
BEE BACK OF PINK PERMIT FOR MORE INFORMATION
FEE
.10-
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCES ; ORB
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREE$ TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt 111
1.
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OFTHIS PERMIT SHALL NOT BE
LandsWeInsp.
Total Amt. Due
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."..
el 117/)
Recording Fee
Receipt #
1 c:;v/ 7 C-1
I HERE13Y 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
THE MER. I AGREE TO COMPIY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit unfit signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or hisfher Deputy: and Fees are paid, ani
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
1
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN — - NBATISOAkSURANC AND RCW 10.27.
OFFICIALS PIGNATV6E DPTE
SIG:::: -&WNER b*GENT)
DATE S NED
IA95)
I
aakX�' Y12614
d
I
771-0220
_
RELEASED BY DATi
ATTENTION
EXT 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
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