20030321.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS L I
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CITY
ZIP TELEPHONE
/-oa;
NAME CBLN
ADDRESS
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CITY ZIP TELEPHONE
JELeja Y W64 1--3 14 0 2
STATE LICENSE NUMBER EXPIRATION DATE
tZIAe-134 14Y-0^riD q--- 14 � --v -3
ROPERTY TAX ACCOUNT PARCEL NO.
d!Q 25:Z&
M"NEW
M-IRESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
13 REPAIR
GRADING
CYDS
1:1 DEMOLISH
TANK
0 GARAGE
cARPoF;rr
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
_1
DESCRIBE WORK TO BE DONE
tl / -
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0 PLUMBING/MECH
COMPLIANCE OR
1:1 CHANGE OF USE
0 siGN
Err( �9�
X FT)
W_ Ak
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER LA ItT,
LERMIT EXPIRES
P
USE PERMIT
ZONER.0
NUMBER
JOB
SUITEIAPT#
ADDRES:2,2,e/6 9'pq_�,j,
"el
(e.1 4!�,
PLAT NAME/SUBDIVISION NO. LOT No.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY hR OFFICIAL STREET MAP
TESCP Approved
Rw Permit Required
EXISTING — PROPOSED
Stra at Use Permit Asqd
Inspection Required
Sidewalk Required 13
REQUIRED DEDICATION— FT
Undo Wound
wiling, required 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES E31 NO 13 Z
- I
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
10c,finlomc—
DATE
FIRE REVIEWED BY DATE
cc
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______FINSPECPON BOND
VARIANCE OR CU SHORELINE OR ADB# D POSTED
%_ I IM17Es E3NO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALI PROPOSED
:XP
;= - LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PLANNING REVIEWED BY DATE
PARKING LOTAREA
REQ`D I PROVIDED I
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so rnax /Tf- I;c 6 -" 0
CHECKED BY
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OCCUPANT,9.9
-ORO
SPECIAL INSPECTION
AREA
OCCUPANT
REQUIRED [3YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1018/FINAL INSPECTION REG-0
$ ___1
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
k).2 1 1 _2
Mechanical
THIS PERMIT AUT140RUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
PERMIT LIMM I YEM - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Inspection
N 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
Landscapeinsp.
Recording Fee
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
CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
GIVEN IS
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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIO N
WORKMEN'S COMPENSATI 4 INSURANCE AND RCW 18.27.
(425)
SIGNATURE (OWNER 0 AGENT)
DATE SIGNED
771-0220
Plan Chk. Deposit t!IL2
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
"Iplicallon is not ari'mit until signed by the
ci.1 , hllh., D puty: and Fees are paid. and
.Et 15 acknowledged In space plovided.
ATTENTION F.J% I I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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PINK - NER - GOLD -ASSESSOR
GREEN - ACCOUNTING
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Dat si
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MEMO TO: PERMIT COORDINATOR, BU11DING DIVISION
FROM: —FIRE DEPARTMENT DATE,
T-22Y)"k ENGINEERING DIVISION DATE '1&Z1q;r3
Mf
nAMSM
PLANNING DIVISION DATE
R"Sw
SITE ADDRESS
PERMIT --.ADB# DATE INSPECTED
,,':,.'..DESCRIIPTIONOF.WORKTOBEINSPECrED 5� 4&eeg� ::2��
mal compliance with approved plans.. Final approval
A field inspection was conducted to determine r
are In above signed Department to the release of
denotes that there no objections fro the
ting of
PERFORMANCE BONDS and the gran
GRANT FINAL PROJECT APPROVAL
T APPROVAL WITH CONDITIONS NOTED
GRANT PROJEC
Q Copy of COMMONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a COPY of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE_INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing................. ......
Wall .........................
Pier/Porch .................
M*,
Retaining Wall ...........
Slab insulation
ca
PLUMBING:.
M
Underground .............
Rough -In ....................
Commercial Final ......
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UMAINKIn.
INSULATION ...................
Floor insulation .........
will insulation ...........
ca
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
I TDATE RECEIVED
_CITY OF EDMONDS
CON6TRUCTION PERMIT APPLICATION
I OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
/f/e/ 1-26
CITY ZIP TELEPHONE
L.14.
NAME
E
ADDRESS
z
lot 5F
CITY ZIP
TELEPHONE
Jrillve_ LAIA
0?6
him
NAME CBLN
ADDRESS
/11/0
CITY ZIP
TELEPHONE
A Y97-
--Z J4 -0 2c'-
STATE LICENSE NUMBER EXPIRATION DATE CHEC"Y'
r -01? Af/
pl- , 1:2=rj ]z
PROPERTY TAX ACCOUNT PARCEL NO.
grNEW. M-IRESIDENTIAL PLUMBIkG/.,MECH
[j COMMERCIAL COMPLIANCE OR
ADDITION CHANGE OF USE
0 REMODEL 0 MULTIFAMILY SIGN
GRADING CYDS (:Ef
REPAIR X/, FT)
0 D . EMOLISH 0 TANK a_oTHER
[3 GARAGE RETAINING WALL o FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
UWE OF BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
_J�9 e M1 C' -f�
EPER�MIT EXPIRES
UsEfp PERMIT
ZON
V
NUMBER
JOB
SUFTE/APT#
ADDRES�.25el, 7 P/ ("/
PLAT NAME/SUBDiVISION NO.
LOT No.
LID NO.
4'-a0'/
LID FEE S
PUBLIC RIGHT OF WAY bER OFFICIAL STREET MAP
TESCP Approved
RW Perrntt Required
Street Use permit Roqd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
YES E3 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FIR EROSION CONTROUDRAINAGE
h1c,ro-netic. e.,Wn AQAL,
ENGINEERING REVIEWED BY
D - r2t
FIRE REVIEWED BY
VARlAqCEORCU I JSHOREL[NgOl� APB#
SEPA REVIEW '4 SIGN.AREA_'
COMPLETE , EXEMPT ALLOWED PROPOSE6,
EXP
1. LOT COVERAGE 11EQUIRlW-SEiGACKS (Fr.)
ALLOWED PROPOSED FRONT' SIDE REAR
PARKING LOT AREA I PLAPNING REVIEWED
REO'D I PROVIDED 1 1 _14-7-7-T
LJA I t: U11
IM
T)N BOND
POSTED t
N 0 $
HE HT
.LOW9D PROPOSED
OPOSED SETBACKS (Fr.)
IONT LIRSIDE REAR
z
3Y DATE,
F-e-,: p e . z, I,< -z4hafck- din-14
twc 1:::P'& Ac
�, , So "4x A* 1, 6 .1, —
CHECKED BY TYPEfej=N OCCUPANT
GR 02,
SPECIALANSPECTI07NAREEA OCCUPANT
LOAD
REQUIRED [3 YE 1
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
VALUATION V
$
Description
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE
07
Plumbing
2
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MMQUIEES. ETC.) WILL REQUIRE
BEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: IIWDAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE 13ACK 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 CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALLjNOT BE
Landscapein,sp.
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE P70VISION."
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE
tORMATION
GIVE IS CORRECT, AND THAT I AM THE OWNER, OR THE DULN AGENT OF
N I
C
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS 1 CONSTRUC-
CALL
TIGN; 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 INSPECTIOIS
WORKMEN'S COMPENSAT52a I�kURANCE AND RCW 18.27.
SIGNATURE (OWNER AGE" 0 E SIGNED
1142
45
-/7-o3
771-0220
XTTANT1
EXT 1333
FEE Description FEE
State Surcharge
City Surcharge 757:7
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
Tift-lipplication is not a permit until signed by the
paV\1ng3111cIjaj13orchIn1hof Deputy: and Fees are paid, and
I Ain a k ovoodood In aDace movided.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
WIN
RIAINA�-_FaJi--) YELLOW,'INSPikCTOR
PINK-bWNER - GOLD -ASSESSOR
GREEN - ACCOUNTING
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