20030404.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
— 6�Qlu
MAILING ADDRESS
- q9) VL
CITY ZIP TELEPHONE
%
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBLN
ADDRAS
%
A)c 1o2'1
CITY ZIP TELEPHONE
I jA)d1jSjVQj! I iLfZV_.-_.3 -
STATE LICENSE NUMBER EXPIRATIC) DATE
W"-CT'04'4-4�1 Llth� /1 0
NEW
RESIDENTIAL
ADDMON
COMMERCIAL
REMODEL
MULTIFAMILY
��Iqll_
GRADING CYDS
13 DEMOLISH
0 TANK
oGARAGE
CARPORT
o RETAJNINGWALL
ROCKERY
ME OF USE, BUSINESS OR ACT,;M
t
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO
BE DONE
W�
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPER7V ONLY, ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: ISODAYS
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
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 SHALL NOT BE
Landscapeinsp.
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. -
Recording Fee
I HERESY 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-
CALL
TION; AND IN DOING THE VIPMt-ALTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE 0 OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEf?8 ON INSU CIE AND RCW 18.27.
COMPE!!!��
sladrui IfIR AGENT) I I
DATE SIGNED
(4251
771-0220
A17ENTION M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN'rIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
0 SIGN
FENCE
FT)
OTHER
0 FIRE SPRINKLER
FIRE ALARM
lo5
PERMIT EXPIRES
1
11SE PERMIT
ZONE
1
NUMBER
JOB V
ADDRESS
(.)o Vr SUITE
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESC? APPf0v*d
RW Pernift Rfquif*d
Street Use Pormh Req'd
EXISTING — PROPOSED
inspection Required
Sidvwa* Required
REOUIRED DEDICATION— FT
underground
Wirina required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES (3 NO 13
REMAfn
C
OWN C IQV..gPN
ROL/D E
Open or clo-qarl
_401em I
water tanks
BY
VAIL CUCI
or L vent connectors Ir
BOND
SEPA REVIEW
COMPLETE
EXEMPT
ALLOWED
PROPOSED
ALLOWED
PROPOSED
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
_jfVAPMb*EW
PARKIN
RECI'D I PRVA WbRft
BY DATE
CHECKEDBY
OCCUPANT
cu
JTYPE��
[W
GR P
CRITICAL
AREAS
SPECIAL INSPECTION JARtA
IREMARKS
OCCUPANT
NUMBER
REQUIRED 13YES
OAD
2
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION HE
VALUATION
$
LP
Description FEE DescriptIon FEE
Plan Check State Surcharge
I City Surcharge /S-
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
PPUCATION A 'ROvAL
Flis lication is not a permit until signed by the
cW or his/her Deputy: and Fees are paid, and
11'.11i"Pt Is acknoyAodWd In space provided.
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
z
0
4
0
M
- - . I � - � - - - . . .
0
p
r
k d
r
RECORD OF INSPECTIONS
4 0 t I
t
d
INSPECTOR DATE APPROVED
L
I d
I d 1 41 1
SETBAC
p d
d 11
P, I
d
I,. .e 1A FOUNDATION
I p
p 4
*6: Woo a 0
fS 94
d '6*F
d 1
't� I t'. �Id V� I p
Z P.
Pier/Porch
4
4 4
L
m
.,Rptainlrig Wall
j p j.. I
I d
Z�$
I I d
L VL ; I .
4 Slab Insulatlorv.,
4 r
�o (Ife; P, p
I d r
i ter I I Iit, 0;
-It Ld r'
41, 1- .. I I ; . IL
IN. 1 '9 p L . . k . L I
L I
Lp, I+ rr I d, L
G:'
I
1 % d I
I d I 1 .1 9 1 1 1 L p r
p I d Lr . I
I F L I
I %
-L' + P., L ... . .... L L
1 Underbrodnid
p I
L I L t
p I
9 t d, I i I t I
1 17 r I I%
L 'L�, It 'i
d L
- L L, R6ugh-ln 4.1
9 % L
.60 L L L ok r-r
% M I
p
L. ial Final
L L' m erc
I I I L 4 9
m
p
I . d 1. 9, 4. p I + L p I
I
.: . 10
..L 1 1 1 rp 4 1
9 - . L 1 9 r HEATINGII 9 r p 9 r I L L 9
d 4
4
C Z
P, L
9 IL I I , ; I : I
�Ifq .; �,. I. A 1 4' i
d 0 1 L' r
p
9 d, I
Ott: I " $a . . P't
to 4
L r , ":,� II.I., . " I . 9 L r� to
I r
I L, 104. .. � I I I , I
4 1 t 1 4
d
I
r 91 1 9, ;h-'. I d
I A4 , 4 9
d �,,..L(US'Plpjng L r.1
r, Ica
4 1 1 1 1 I� d If e ';1, -1 "Z 4 r k r L I r r r I I F I A
I I I d f 9 1 1 r r I d
I. I I % I I t I L 0 I� I 'r I I I I I . I
r IT 9 1 1 1 't� I LL I I I j, I 1 4 1, 1 4 9 . I 1 9 1 % e I d L I I I L I L % I r L I
I j ��4, �i.Eq6ipmear; % L L. r
0 p 114690600#
'h dr L L
L L 4 r Corn M 16 1 na I L
L. L erc
4 p I I I
I I d I r L I.
r 4 L
I L
I . I , d r L r 3 . L d
p I I I .
I e;, t I I . I I r I
1 0 4
'I, I L I L L 4 EXTERIOR SHEATHING L L:
't NAILING
.p
d C:
d
d
r;
d t
1 1 L
r 4- . FRAMING
p 0.
d it
p
4 FIRST FLOOR,FRAMINGese
P,
L
I I .:,L 4 r r L I I I I p I
4,1
d L .1 1 1 r d
I J
t LL
X 3;' JNSULATIOJN�
I p I
p r I L p
.1 . . I I It d I
p
1 P 1. 0 .
-1 L :FloorInsulatlon
LL' Lk L
P,
d
4 %Wall Insulation I p
Ceiling Insulation Z.
t.41
d .
k
p
got
'T,p ShEETROCK NAILING 42
d
p
p
m
SPECIAL INSPECTION
1. 4 1 1 1
+
p - I tj"�;
d I . I�
MISCELLANEOUS
Y.
I 1 4 j, . I .
d
(V)S !
T I r I . . , . + L
FINAL APPROVAL FOR
d I d
OCCUPANCY
L
4 'r p
44
4
t
Id
p
p
4
L L ,
4
p
4
p
Ij,
t
DATE RECEIVED
o PERM IT EXPIRES
N'—,
_'j-
Now
CITY OF EDMONDS
IIISE PERMIT V
ZONE
NUMBER
COOSTRUCTION PERMIT APPLICATION
JOB
ADDRESS V) U0j( SU"V"
OWNER "EINAME OF BUSINESi__
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING AdDRESS
LID FEE $
TESCP Appmed
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP SW PerfM R"Ulfed
Use Peffnit
CITY ZIP ELEPHONE
SUM Wd
EXISTING - PROPOSED IngpecUm Requimd
Sidewalk Req Irod
_Z0 IT
Undargmund
REQUIRED DEDICATION- FT WIdng roquked 13
NAME
METER SIZE LINE SIZE FNO. OF FIXTURES PAV REQUIRED
YES 13 NO 13
z
A013RESO
REMARKS
:A
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY, TELEPHONE
A# wk.a_ AL
Is
open or doeM. ax
tqu: or
NAME;.. CBL#
Mtpftd on d hot water fan!R P
ENGINEERING ECDC 19.30.UO (C) DATE
ADDR AS
vv)
1 0
i�,�
FIRE REVIEWED BY DATE
W
cc
"",
I
CITY ZIP ITELEPHONE
M
L(Z ; 6
L IM ")!:ij 0 0 _7?5- (4
VARIANCE OR CU BOND
;U NN' 'FIM 11 POSTED
STATE LICENSE NUMBER EXPIRATIO) DATE CH
E
U
PROP AC UNT
SEPA REVIEW
EW
COMPLETE EXEMP D PROPO BED
XE T
MPT
yr
EXP ne
NEW [0 PLUMBING mEcH
P RESIDENTIAL
LOT COVERAGE PROPOSED SETBACKS (Fr.)
G S
REQUIREDS
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
f
COMMFRCtAL COMPLIANCE OR
Cj ADDITION 13 11 CHANGE OF USE
MULTIFAMILY [:1 SIGN
PARKING NING REVIEWED BY DATE
LOT ARIA PLAN
RECID PROVIDED
06
L
I
GRADING FENCE
CYDS X FT)
REMARKS
DEMOLISH TANK OTHER
Tnm B or E vent connix-tors
GARAGE, RETAJNINGWALL FIRE SPRINKLER
1:1.'ROCKERY
N111wred Un fical." UrIAS I Pfth%AF-M
CARPORT.- FIRE ALARM
(ME OF USE�SUSINESS OR
T 191 !2 - ---
CHECKED ]TYPE Of ION 4 OCCUPANT
rm_
A
NUMBER NUMBER OF
OF DWELLING AREMACSAL
_&STnUCT
11
It
SPECIAL INSPECTION ARtA OCCUPANT
STORIES UI*TS NUMBER
REQUIRED LOAD
[:I YES
DESCRIBE WOA.K TO BE DONE,,
REMARKSJU
PROOR PER UBC 1081FINAL INSPECTION RECIID
OF
2 ISLL W) 11slil
Maw zip
VALUAnoN
$
Descriptlon
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SWXE % LOT.'slyo
Building Permit City Surcharge
PLAN CHECKNO: VESTED DATE
Plumbing
Mechanical
THIS PERMITAUTHORIZES ONLY TM WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRWTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISGION.
-
Engr. Review
PERMIT APPLICATION: IGO DAYS
PERMrrUMM I YEAR - PROVMW WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PtRUIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFPa", EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
---
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REOLICE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO kNFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt # I :M
I HEREBY ACKNMYLE06E THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAI
GIVEN 18 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 T 9 Is not a permit untH slQnod by the
=Isftw
i
TION; AND IN DOING THE D THEREBY, NO PERSON WILL BE EMPLOYED
B Deputy: and Feea are paid, and
AM
IN VIOLATION OF THE HE STATE OF WASHINGTON RELATING TO
OMKOF7Ti
FOR INSPECTION Is acknowfedqpd In space proyided.
WORKME 8 PE N INSUI AND RCW 18.27.
Nj_
a URE
U
DAT70'
DATE SIG
BIG U WNAR NED
11
1A9 / _?
%425)
®RSEED
WAIGIV
-022
771 0
< BT
ATTENTION
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDINGOR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLCW- INSPECTOR
CATEOF OCCUPANCY HASBEENGRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
z
9
0
ITI