20030359.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBLN
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CITY ZIP TELEPHONE
)r-t? I I PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS 0
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCIR Approved
RW I's"rit Required
street Use Pernill AKd
EXISTING — PROPOSED
Inspection Requited
Sidewalk Required
REQUIRED DEDICATION— FT
1 underground
VVMU FUqUUeu
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13 z
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU
SHORELINE OR ADBI
INSPECTION
BOND
STATE LICENSE NUMBER
EXPI ION DATE
REO'D
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POSTED
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E3YEs 13NO $
SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED ED
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0 121
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EXP
_PROPOS
NEW
P'oo"RESIDENTIAL
0 PLUMBING / MECH
LOT COVERAGE
ALLOWED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SET13ACKS (Fr.)
FRONT LIFISIDE REAR
PROPOSED
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
REMODEL
MULTIFAMILY
SIGN
REOD
PROVIDED
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REPAIR
FENCE
[j GRADING CYDS FT)
REMARKS
DEMOLISH
TANK jzO A Y\ n
GARAGE
CARPORT
RETAININGWALL FIRE SPRINKLEk_3
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS GR=N:
CHECKED 13Y
OCCUPANT
1"Ar-C-0
ME
GROUP
NUMBER
OF
NUMBER OF
WELLING
CRITICAL
AREAS SPECIAL INSPECTION
OCCUPANT
STORIES
UNITS
JARtA
NUMBER REQUIRED [] YES
LOAD
DES�kIBE WORK TOIBE
DONE
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. REMARKS
PROGRESS INSPECTIONS PER USC
1108/FINAL INSPECTION REG'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC-) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 180DAYS
Its. PERMIT LIMM 1 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
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Ld
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
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
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and F003 810 paid, and
receipt Is acknowledged In space provided.
WORKMEN'S COMPENS SURANCE AND RCW 18.27.
OFFI DA E
S]NjjREj(9"R
DATE SIGNED
IA0
1425)
7IGNNfURE
t 0-,/
6a j
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771-0220
RELEASED BY /DATE
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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DATE RECEIVED
I CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
ZZ. - -2ckpt
CITY ZIP ITELEPHONE
NAME
ADDRESS
CITY ZIP TELEPHONE
NAME
Le Qo()Iqr\�
CBLN
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ADDRESS -3
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CITY ZIP
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PA m o p � ;,�)
TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
Pc rz-s- WS "Ib (110Z �64
E
PROPERTY TAX ACCOUNT PARCEL NO.
-) on 0 Yi-
NEW VRESIDENTIAL PLUMBING MECH
0 ADDMON COMMERCIAL COMPLIANCE OR
CHANGE OF USE
0 REMODEL muLnFAmfi.Y SIGN
GRADING FENCE
REPAIR CYDS U ( X— FT)
DEMOLISH TANK 0
;y
oGARAGE RETAININGWALL F,RE SPRINKLER_-)
CARPORT ROCKERY F RE ALARM
(TYPE OF USE, BUSINESS ORr
NUMBER OLLING CRITICAL
'I NUMBER OF
OF DWL AREAS
STORIES UNITS NUMBER Qpr
DER�XIBEM,]�r DONE
P\M NO 2 -! Adl h j
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURS8. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) W1LL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICATION: 1180DAYS
PERMIT UMM I YUn - PROVIDED WORK 18 STARTED WITHIN 180 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 PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR UL41T IN ANY WAY THE CITY`8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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
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 LWR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMERS COMPENS#AbN4Ik8URANCE AND RCW 18.27.
DATE SIGNED
,-\ e� - —V\ &-\ -
U -
PERMIT EXPIRES 11 16-t-4 U-
USE PERMIT
ZONE
NUMBER 200
C3
- 0,
JOB
UITE/APT#
ADDRESS 7_1 o
PLAT NAME/SUBDIVISION N071
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP App"rild
RW Permit Required
T
Streel ties Peffnh R6q'd
EXISTING — PROPOSED
Inspection Required
Sidews& Required
REQUIRED DEDICATION— FT —
undorwourid
WkingrequIred
METER SIZE
LINE SIZE -]
NO. OF FIXTURES
PRV REQUIRED
I
YES C3 NO 13
z
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE �.
11
DATE
FIRE REVIEWED BY DATE 111!
WAMIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REO'D
113YEs
POSTED
1$
13NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
I
ALLOWED PROPOSED
EXP
,
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
PARKING
LOT AREA PLANNING REVIEWED BY
DATE
REO`D PROVIDED
I
�j I,
REMARK A&AMOMMI
===Nk
CHECKED BY ITYXF CO,� OCCUPANT
GROUP
C?
SPECIAL INSPECTION JARfA OCCUPANT
REQUIRED r LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION RECtD
-7 t,--/1i,7 n /--Z- / A k,-,6K11171,-A I a
$ F
, - --
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
I
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt
CALL
FOR INSPECTION
IA95)
1,42
771-0220
APPLICATION APPROVAL
This application Is not a Ormit until signed by the
B411ding Official or Matti I or Deputy: and Nos are paid, 4knd
receipt Is acknowledged in space prov4ded.
OFFIQMS,AIGNAXURE D E
11,114
RELEASED BY ATE
MENTION LK I 1;j;jj
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 - INS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSESSO
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
L .