20030398.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
Ethel Bulnowski
MAILING ADDRESS
8418 187 St SW
CITY ZIP TELEPHONE
Edmonds 98026 1425-778-0817
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ADDRESS
CITY ZIP ITELEPHONE
NAME ICBLN
ADDRESS
12601 132 Ave NE
CITY ZIP TELEPHONE
Kirkland 98034 1425-814-3124
STATE LICENSE NUMBER
=10=4=
PROPERTY TAX ACCOUNT PARCEL NO.
2)
PERMITEXPIRES t 13
E PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS 8 4 18 18 7 S t SW
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pernit Required
street U a Permit Rsq'd
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
UnderWound
WiringfequIred 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO C3
REMARKI
OWNER/i
is open of closed, expansion tanks' are --
required on all hot water tanks per
wity IVIX110". ECBC M.30.020 tc!
ENGINEERING
FIRE REVIEWED BY DATE W
cc
Ir
VARIANCE OR CU SHORELINE OR ADB# I INSPECTION 1$ BOND
REO'D POSTED
13YEs 13NO
SEPA REVIEW SIGN AREA HEIGHT
COMP __ ---1'-- .1-0,10) nn DnQon —AllnwF:D— OPOSED
L
NEW RESIDENTIAL PLUMBING/MECH ALLO
ADDITION 0 COMMERCIAL COMPLIANCE OR
CHANGE OF USE
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L veni conn&t
FD):MMoP0jnj
unhea
PEIM
aces. UNIC 231.51.7
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REMODEL
MULTIFAMILY
[:] SIGN REOD
I PROVIDED
REPAIR
GRADING
CYDS
FENCE
( X FT) REMARKS
DEMOLISH
TANK
OTHER
F
GARAGE
CARPORT
RETAININGWALL
0 ROCKERY
o FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXP
C,pz, —
NUMBER NUMBER OF CRITICAL
OF DWELLING A AS
STORIES UNITS NREMBER
DESCRIBE WORK TO BE DONE
__raMgy_g/rej2jace gas water hea
in hall closet 40,000 btu's
- A J11 A 19 J A Y f,;, Ja_412 L/I "I IN I 1� --
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 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 CffYS 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPEN!��CE AND RCW 18.27.
SIGNATURE (OWNa OfiAbENT11 I I DATE SIGNED
CKS (Fr.)
REAR
06
CHECKED BY ITYPEJ?= I C& OCCUPANT
GROUP 0
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:1 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108JFINAL INSPECTION RE=
VALUATION
$ yq —
.f pe I
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Description FEE
State Surcharge
City Surcharge
LIZ,.* < , 0
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
- OVAL
APPLICATION APP
CALL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged In space provided.
I
OFFICALS SIG ATURE
--r /1)kl
142
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771-02,20 RELEASED BY I OATE
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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