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DATE RECES 1115 103 L
PERMIT EN
USE PERMIT
CITY OF EDMONDS ZONE bc NUMBER
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS Z-3 -lyka 'I V)
OWNER NAMEfNAME OF BUSINESS
SUITE/APT#
tj Clt- W "L-< PLAT NAME/SUBDIVISION NO, I LOT NO. LID NO.
MALING ADDRESS
CITY ZIP TELEPHONE
f01 6 01z' _&
_�Aj M 0 tj f Y) 9 1 0 7L
NAME
ADDRESS
CITY
NAME
pe'e—y' IL."o
ADDRESS
ZIP ITELEPHONE
LID FEE S
TISCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
'W ps"W, Raqukbd
street use Peffnit 1`190
EXISTING — PROPOSED
inspacwn ftiquited
Sidewalk Required
REQUIRED DEDICATION— FT
U,ndwWound
wiringrequired 13
METER SIZE
NO. OF FIXTURES
RV REQUIRED
P U
0
LYES"EV3 NO E3
REMARKS
OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
—1 _Q'411V6 AMY
ILO
, II ENGINEERING REVIEWED BY
CITY ZIP LEPHONE
q8 rE
60 - 491
EXPIFL
CHECKED BY
,17ION DATE
qMj LICEVSE NUMBER A�
7-
NEW
RESIDENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANCE OF USE
REMODEL
muLnFAmiLy
SIGN
0 REPAIR
GRADING
CYDS
o FENCE X
FT)
DEMOLISH
[3 TANK
OTHER
GARAGE
CARPORT
[3 RETAININGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
4_OR tCTIVrM EXPLAIN:
M?E USE. BUSINESf
el
W'Aa j a
1E .02 Aso r
NUMBER NUMBER OF CRITICAL
DWELLING AREAS
OF
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
)p
HEAT SOURCE GLAZING % LOT SLOPE: %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AumoRmias ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATION: 160DAYS
PERMrT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 100 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 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
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 18 CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE ONNNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA DE OF THE STATE OF WASHINGTON RELATING TO
WORKMEWS COMP- NCE AND RCW 18.27.
SIGNATURE (OVOER Q AGE DATE SIGNIED�
1 '51 e" 0 ';�
Oft -
DATE
FIRE REVIEWED BY DATE I I!
VARIANCE OR CU
SHORELINE OR ADSN I
Af
INSPECTION
REO'D
(3YES ff,--I$
BOND
Polo
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
:XP
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
PLANI.NINGI REVIEWED BY
PARKING LOT AREA..
DATE 116
REO`�O�D
j'0
REMARKS
CHECKED BY
ITYPE OF CONSTRUCTION p0jn_
V'761-
0-T
OCCUPANT
GROUP /"
SPECIAL INSPECTION JAREA
OCCUPANT
LOAD 29
REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION RE
$
C
Description
FEE
Description
FEE
Plan Check
State Surcharge
4j 250
Building Permit
104
CitySurcharge
15 CID
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
PlanChk.Deposh
Cl/
Fire Inspection
Receipt N
27ZXA
Landscapelnsp.
Total Amt. Due
Recording Fee -]
I Receipt N
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
APPLICATION APPROVAL
This application is not a permit until signed by the
Building otpciall or his/her Deputy: and Fees we paid, and
receipt Is acknovAedged In space provided.
OFFICIALE, SIGNATURE DATE
_jhc7% I-IM 16 ( 63;i,_
liftLE ATE
<579 j , n
71W (i
11
IT IS UNLAWPUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Fjlc�_ 11 -L %_�� I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- :ILE 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
(Citp of (tbmonbo
DEPARTMENT OF BUILDINGS
ORilk UNIFORM BUILDING CODE SECTION'
At:— 323 Main Street, Edmond ZA annoin 200i*356
k.
No. Stories: 1
Occupancy established by this celtificate: Dwelling Units: **NM"
t'
Typq,.4 V-N Basement: No
M _qnstructlon:
PerjI.I.B.C. 1002)
Maximum upant Load
Room capacity sigri�' st re a t a# times.
inillnm- pi n
Jack M
Owner of Building: MLO A-fAQUIREMENTS OF THE 1997 EDITION OF THE
THE " PPM X 10
House s HAS BEEN INSPE
OCCUPANCY AND THE USE FOR WHICH THE
q
FOR
UNIFORM BUILDING CODE As ADOPTED B
PROPOSED OCCUPANCY IS CLASSIFIED. 9"
Issued this 2003
CHIEF BUiL IN OFFICIAL
BY:
This oedftata shell be posted In a consph"A public area and not be removed, mutilated or obscured and " be maintained In legible condition at all times. Any change ot occupancy or use requires a building permit and a now
CadilicMe 01 occupancy issued by the Oty of Edmonds Building Official.
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=DATE RECE S1 [PERM,TEXP,RES
5105 - �
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
V 4;(.- W
ADDRESS
ZIP TELEPHONE
0 6.42 4) 1 ^ 67L
I-
ADDRESS
CITY
NAME
as—%.
I%.#
ADDRESS
CITY
SATE LICEfjSE NUMBER
ZIP ITELEPHONE
Cal.
rN W
ZIP I TELEPHONE
I'l- 2-- 1 24 &P 2L
EXPIM-TION-DATE _I CHECK
3
&-1
—1
% %_� —
%
N EW
RESIDENTIAL
PLUMBING / MECH
APDITION
60MMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
muLnFAMILY
SIGN
REFr4R..
[3
GRADING
CYDS
o FENCE
X—FT)
DEMOLISH
TANK
o OTHER
o-GARA GE
- CARPORT
[3
RETAININGWALL
ROCKERY
ci FIRE SPRINKLER
FIRE ALARM
USE. BUSINES
q.OR fCTIV1TY) EXPLAIN:
4�r
NUMBER NUMBER OF CRITICAL
�OF DWELLING AREAS
STORIES NITS NUMBER
DESCRIBE WORK TO BE DONE
a
Af A. -
HEAT SOURCE GLAZING LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIs PERMIT AuTIwRjzjs- onLy THE WORK NOTED. THIS PEFtmrr COVERS WORK TO
BE DONE ON PVUVATE PROPERTY ONLY- ANY CONSTRUCTION ON THE PUBLIC
DOMN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE, PERMISSION.
PERMITAPPLICATIOW 100 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 190 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESCIRS
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
DEEMED TO MODIFY, WAIVE On REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT 01 ANY WAY THE CrryS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GFM 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-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE -LA E OF THE STATE OF WASHINGTON RELATING TO
WORKMFRS COM CE AND RCW 111.27.
SIGNATURE DATE SIGNED/
1 '151 a 0.,
USE
ZONE er,
PERMIT
NUMBER
JOB
ADDRESS 2_3
-M n 10
SUni1APT1F
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
mwP Approved
RW Perrolt Rewired
SUM Use Parmit Roo
EXISTING — PROPOSED
Inspection FWqWr6d
Sidewak Required
REQUIRED DEDICATION—
FT
Underground
VVIringfequired cl I
METER SIZE
LINE SIZE
I
I NO. OF FIXTURES
PRV REQUIRED
YES E3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAiNAGE
/) "q e�eth&--O, ave- 06A. 1ye 1UW1,a4_ waga-t—
swkvc rl"y ey
swwl, OV-41
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY
DATE I 111c,
IVARIANCE OR CU
SHORELINEORADB#
I INSPECTION
BOND
/PAIR R
POSTED
S
IC3YEREQ&.1
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
PARKING
LOT AREA
PLANNING REVIEWED BY D
REO'D I PROVIDED
I
]
2
--+- --
--
.1� %W -41-- 5103
REMARKS
CHECKED BY I TYPE
SPECIAL INSPECTION
REQUIRED [] YES
PROGRESS INSPECTIONS PER UBC
OCCUPANT
GROUP /"
OCCUPANT
LOAD
INSPECTION REE12W�D
$ tgl1
IJLj
w3wansm- _11111111111M i Mow
L
Description
FEE
Description
FEE
Plan Check
(q
StateSurcharge
150
Building Permit
I
City Surcharge
Plumbing
2
Mechanical
Or
Grading
Engr. Review
Engr. Inspection
Fire Review
PlanChk.Deposh
Cl/
Fire Inspection
Receipt #
Landscapoinsp.
Total Amt. Due
Recording Fee
CALL
FOR INSPECTION
142
,125)
771-0220
VAL
APPLICATION APPfkd,
TWo application to hoil a WINt uiM eigmd by the
aWdIng otncW or hwftw Deputy- mid Fees am Paid. Wd
racelpt is &&nowtedged in spaw provided.
OFFICLALS SIGNATURE DATE
n _4 _ 7
ATTENtION - f Off 13
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ___ORM�&-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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