20030388.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY TELEPHONE
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Zip
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBL#
MitifIx �,&( cow. 70
ADDRESS
45�5'
CITY5,E ZIP TEKPHO
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—0100
STATE LICENSE NUMBER E
Off I fic 0 -511n3 7--23-03
PROPERTY TAX ACCOUNT PARCEL NO.
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SOEW RESIDENTIAL 0 PLUMBING/mECH
COMPLANCEOR
ADDITION r%9 --d'OMMERCiAL 11 CHANGIE OF USE
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REPAIR GRADING FENCE X
CYDS FT)
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CARPORT ROCKERY 0 FIRE ALARM
(TYPE OF USE, BqPNESS OR ACTIVrM EXPLAIN:
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1-,00F 3
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES I UNITS A9 I NUMBER
DESCRIBE WORK TO BE DONE
t L L M yA
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PERMITEXPIRES
PERMIT
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NUMBER _)�j
(
JOE) SUITE�APT#
ADDRESS 2 3 63 "14 q I
PLAT NAMEISUBDIVISION NO.
LO NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Perrnft Required
it R6q.d
street use Perm t7d
EXIS71NG — PROPOSED
Inspection Required
SidevratkRequiried
REQUIRED DEDICATION— FT
Unclorground
Wiring required
mETER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
I
I YESE3 NO 13
REMARKS
OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE ORADB:#�WjSPECTION
BOND
EO'D
POSTED
S LJNU
S—
SEPA REVIEW
SIGN ARtA
11MOWED
HEIGHT
COMPLETE EXEMPT
PROPOkED
ALLOWED PROPOSED
It4' I I k4
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
PARKING
LOT AREA
I EW 0 DATE
REO'D I PROVIDED I
R BY
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CHECKED BY ITYPE= OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES 9 LOAD
REMARKS 2
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D 19
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VALUATION
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Description FEE
Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
iBuilding Permit Axle)
City Surcharge
PLAN CHECK NO- VESTED DATE
Plumbing
09,
14 4&0 eeslNes'
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE 'HE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
21
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t= SEPARATE PERMISSION. —
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM 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
Plan Chk. Deposit 1/0
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 #
=I
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSLL4,NCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due 55
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY AC E IAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS C RE ;AND I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWN I R T MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
E I
9AN
a
CALL Aldin
11callon Is not a permit until signed by the
TIO ;W I DOING TH ORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
N
let or his/her Deptft: and Fees are paid, and
IN VI'O I OF THE CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION r
o tisacknowiodaedin-bkaeoprovldod.
WORKA ' COMPEN NI RANCE AND RCW 18.27.
F
ATURE DATE
0 ENn DATE SIGNED
(425)
r $2,
45-03
WATURE
771-0220
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BY 1
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IT IS UNLA L TO SE OR OCCUPY A BUILDING OR STRUCTURE 7UNT
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A FINAL INSPECTIO HAS BEEN MADE AND APPROVAL OR A C E F
I - (I) 7j:5:-3::r) \1_j
ORIGINAL -FILE - ALLOW -INSPECTOR
I
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES
GREEN - ACCOUNTING
FINAL PROUECT, APPROVAL FORM
TO: Qe_=
DATE: (a B=0
MEMO TO: PERMIT COORDINATOR� BUILDING DIVISION
FIRE DEPARTIVIENT DATE__.L______L_
MEMSIGN
ENGINEERING DIVISION DATE
KEMSICM
PLANNING DIVISION DATE
-chi 4 a
-PROJECT
ITEADDRE SS_ WIC,
-PERMT'k��'t aS ADB#_�_�..DATE INSP ECTED
15�§CRIPTION OF WORK TO BE INSPECW_D u
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ifiere,, are n,o:. ob' ti ns, from the ove signed De arthlent'- to
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�ANC E BONDS'and the granting of
GRANT FINAL PROJECT APPROVAL.
-GRANT PROJECT APPROVAL�Wrrll CONDITIONS NOTED,
C., ".fCO to owner/contractor by inspector
NDITIONS given
AILED FINAL."INS,PECTION - OUTSTAND INGISSUES
(3 OPY of CORRECTION NOTICE given to owner/c ontractor by inspector
2.,
3.
R -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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C17Y OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
A lei fWA4 drf*IL WVOO
MAILING ADDRESS
CITY
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NAME f
ADDRESS
CITY
ZIP
72y- 17,0
ZIP ITELEPHONE
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, - '. .1 PERMIT EXPIRES
ZONE PERMIT -7
1 NUMBER 2Y )- )—
JOB
SUMAPT#
ADDRESS tlyj
Q363Z
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_ _
PLAT NAME/SUBDiVISION NO.
LO1'NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPr0V@d
RW Parrrdt Required
Street Use Permit Reld
EXISTING — PROPOSED
kispecdon Required
sidewalk Required
REQUIRED DEDICATION-
FT
Undewound
Wiring required 13
METER SIZE
LINE SIZE T
I
NO. OF FIXTURES
PRV REQUIRED
I YES 13 13
REMARKS
_NO
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
NAME CBLN
70 ENGINEERING REVIEWED BY DATE
ADDRESS
45'5 WrI40 Af, FIRE REVIEWED BY DATE
CITY ZIP TE�EPHO
.VE
E
I — - VARIANCE OR cu SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER DA -4REOD POSTED
1
LO
AK:>� I s ONO
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Af(# yllf OPIQ 7-23,03
IN
SEPA REVIEW SIG HEIGHT
OeLOWED
_JEB
PROPERTY TAX ACCOU CEL NO COMPLETE EXEMPT ALLOWE D PROPOSED
00 jq I L41
EXP
I
PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (Ff) PROPOSED SETBACKS (Fr.)
FI—FIESIDENTIAL f ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR I
0; COMPLIANCE OR
0 DMON MMERCIAL CHANGE OF USE
PARKING REVIEWED BY DATE
MULTIFAMILY GN REO`D I PROVIDED LOT AREA PCI
1:1 REMODEL 13 W,
REPAIR
GRADING CYDS
FENCE
0 X—FT)
REMARKS
DEMOLISH
TANK
OTHER
oGARAGE
CARPORT
o RETAJNINGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF,USE, SUANE88 OR ACTIVITYI EIJIPLAIN:
CHECKED BY
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPE
STORIES
UNITS
NUMBER
REQUIRED [3
DESCRIBE. WORK TO BE DONE
M6 L"L
f t L tA M Wit fEp
REMARKS
PROGRESS
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viflyL
(11f ow Plf
VALUATIM
HEAT SOURCE GLA23NG % LOT SLO�E %
T-
PLAN CHECK NO: �LDQ VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRNEWAYS, MARQUEES, ETC.) MLL REQUIRE
SEPARATE PERMISSION.
PEnM1ITAPPUCATION: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;=SF.ToN BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 DIRECUY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE IIIAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 18 C RECT, ANDAIIAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Description
Plan d heck I I
Plumbing
Mechanical
Grading
Engr.' Review
Engr. Inspection
Fire Review
Fire Inspection
Recording Fee
OCCUPANT
GROUP
AREA OCCUPANT
LOAD
108/FINAL INSPECTION REaD
d
FEE Description
.Z=— State Surchame
llyt), -' I City Surcharge
5 rf, rz/�0/1, MA
Plan Chk. Deposit
Receipt #
Total Amt. Duo
Receipt #
JCATION APPROVAL
. — —1# Until al ed b- the
N I nfda
THE OWN . I AGREE T
1H
TIONj AN DOING TH
MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
ORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL
W.
end ft.. Me paid, and
IN V 0 1 OF THE
I$E
CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
rVW=�,rDpN
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Ill co Provided.
4 C1
WORKM COMPEN
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I RANCE AND RrW 18.27.
URE,
DATE
NATU 0
SIG I
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DATE SIGNED IA25)
771-0220
fL
DAT
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WA 333-')
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IT IS UN L TO
44
SE OR OCCUPY A BUILDING OR STRUCTURE UNTI
A FINAL INSPECTIO
S BOECENtMADE AND APPROVAL OR A CEBTIFI- (I ) 1 3:5]_)
ORIGINAL - FILE
NkLLOW - I NSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER
GOLD - ASSESSOR
04/02
1C:Q
PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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