20030406.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
CITY
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NAME
ADDRESS
CITY
NAME
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ADDRESS
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STATE LICENSE NUMBER
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ZIP TELEPHONE
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ADDITION
COMMERCIAL
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MULTIFAMILY
REPAIR
0 GRADING CYDS
DEMOLISH
0 TANK
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PORT
RETAININGWALL
ROCKERY
(TYPE OF USE. BUSINESS 00 ACTIV" EXPLAIN:
NUMBER NUMWR OF
OF DWELLING
STORIES UNITS I
DESCRIBE WORK TO BE GONE
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PERMIT EX ES
USE PERMIT
ZONE
NUMBER
JOB
ADDRESS sr�__
SUITE/APT#
PLAT NAME/SUBDIVISION NO. 7T No.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL 7ET MAP
1E11P Ap,=
RW Par. , "ad
Street Use Permit fWq'd
(Co
Inspection Required
EXISTING PROPW
Sidewalk Raquir6d
REQUIRED DEDICATION— FT
Underoround
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YESD NO Ell z
REMARKS i
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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jEW3INF,EFk1NG REVIEWED Y OF, D TE
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Age 'Ve7
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FIRE REVIEWED BY DATE T-.
ION DATE CHECKED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
SHORELINE OR ADBN I INSPECTION BOND
REO'D STED
02
113YEs ON6 is L -
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (FT.)
ALLOWED FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT 141`1 SIDE REAR
PROPOSED
ov,
COMPLIANCE OR
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29. .00
CHANGE OF USE
SIGN
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RE11D PROV aDE
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REMARKS
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OTHER
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FIRE SPRINKLER
FIRE ALARM
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CHECK5 BY TYFi OF CPNST.9UCTION CODE
OCCUPA
.-IZN-- 1!3-7. GROUP L) I
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [3 YES 1_2 LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 106/FINAL INSPECTION REQ'D I
_— , _—� I%— — — - A AA.A.."7 11
rope_ 63
cd Descirlialtion FEE Description FEE
Plan Check State Surcharge qf 50
L/ — LOT SLOPE % Building Permit city Surcharge
PLAN CHECK NO:
VE ED 0 TE
Plumbing
Mechanical
0
lk
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PiRMWCOVERS WORK TO
-5be
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
Grading
DOMAIN (CUjjaS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
Engr. Review
PERMITAPPUCATION: ISO DAYS
L PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 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 MATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
Landscapoinsp.
Total Amt, Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
.97
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
q
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
Building Official or hisfher Deputy: and Fees are paid, and
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
FOR INSPECTION
receipt Is acknowledged in space provided.
WORKMEN'S C NSATION I NSURANCE AND RCW 18.27.
OFFI I GN E TE
Mal&
DATE SIGNED
1A10
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771-0220
ASED ftHY WA It:
13Y
AWENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
M 1333
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW-
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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Height Calculation/Grading Verification Worksheet
Address: Pem3it #:
Date:
A. Datum Point: VA t
B. Datum Point Elevation:
C. Average Grade:
-7-Y(average grade)+ 25?
3. Maximum Ele0ation, Allowed: `�I
4.. Reierence Point Elevation Shot to Houip.-'
(datum elevatlon74r (grade to "nsit level line shot to hous�) F.p.
6. Measurements from line shot onto house to.roof ridge:
I C),
'Total: J
(reference point elevation)
&,�4m i2sarements ftoin
7. Actual Elevation:
Conclusion:
1,11.SZ - (ActuaQ 4 greater/ less than 11 q. (allowed).-gth4reforethe-hoziseW
Is not over the height requirement per ECDC 16.20.30 requirements
L-NTEbflKaugzp4GWMCVkW CakWafionGmding Verifiation Wbrkdw6tAod
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j IDATE RECEIVED
[PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NILIMBER"J_C'�go
JOB 01H'rC1A0T#
CONS RUC I ION PERIVIR .. APPLICA I ION
ADDRESS
C, ER NAMENAME OF BUSINESS
5VWCC& -fre Im a ov,
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
J5
MAILING ADDRESS
LID FEE $
Via Fine _5tr_&:r
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL :7ET MAP RW Porrr9t Required
street Use Parmh Racfd
W Inspecdon Requirod
CITY Zip IE
EXISTING PROPO D
Sidews* Required
W4
REQUIRED DEDICATION FT UW-V--
Wiring required
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES E3 NO C3
ADDRESS
R RKS
0 WE 4CONTRACTOR RESPONSIBLE FOR ER OSION CONTROLJORAINAGE
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CITY ZIP'.
IT,ELEPHONE
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NAME CBL#
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ADDRESS
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FIRE REVIEWED 13Y DATE
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.CITY ZIP TELEPHONE
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STATE LI&E—NOE NUMBER EXPIPATIONDATE CHECKED
VARIANCE OR cu SHORELINEORADB# INSPECTION BOND
REC'D POSTED
OYES SWO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOU PAAR
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
�EL
M4 001
EXI, 48 no
,
NEW 0 PLUMBING/mECH
Ml)(KSIDENTIAL
LOT COVERAGE REQUIRED SETBACKS (Fr) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONIT VR SIDE REAR
A ITI 0 COMMERCIAL COMPLIANCE OR
066 ON 11
3u z3%. zo T zo 1295 00 A4
261
CHANGE OF USE
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REMODEL 0 MULTIFAMILY SIGN
PARKING LOT AREA PLANNING REVIEWED BY DAIJ
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REOD PROVIDED &.00 01 /03
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2. Z 6
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[3 REPAIR [j GRADING FENCE
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W
CyDS X FT)
REMARKS
eXis
DEMOLISH TANK OTHER
E- RETAININGWALL 0 FIRE SPRINKLER
116ARPORT ALARM
ROCKERY F RE
A*A'J�.
Qm ACTIVITY11 EXPLAIN:
CHECKED BY TYPE OF QPNS'jRUCTION JCQDE OCCUPANT
see-
GROUP
U I
NUMBER NUM&R OF _64
OF DWELLING AR EAS
SPECIAL INSPECTION JAREA OCCUPANT
U NUMBE
STORIES NITS
LOAD
REIG U IRED [:] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
A ill A
h5
Aft A% om 0 Wk 9
lez
VALUAnON
a4&6 (OeA
$
PY&-e anj
Description
FEE-
Description
FEE
(it
Plan Check
State Surcharge
ICE LOT SLOPE %
k_J1
Building Permit Surcharge
city
PLM CHECK NO: VESTED EyffE 0' 1 1 9_
Atfnib�g 44 1
2)IIAO
2
Mechanical
TMG PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
k: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
11 1
3 DOMAIN (CURSS, SIDEWALXS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
h SEPARATE PERMISSION.
2
Engr. Review 59
PERMIT APPUCATION: 180 DAYS
—
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SE9 BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCEsons
Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CrrY OF
AND
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY
Fire Inspection Receipt # 21910
ALL mmms FOR DAMAGES OF WHAtEVER NATURE, ARISING DIRECTLY 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
Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
'I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
'GIVEN
APPLICATION APPROVAL
IS COARE" AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. "I AGREE TO COMPLY WITH C17Y 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
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMENG C CE AND RCW 10,27.
_9MNSATION INSURAN
OT 6 IGN E D TE
$I E E A DATE SIGNED
IA13
11425)
771-0220 _R'
t' ABED BY DATE
A'ITENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
—zd
2
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTAFI-,
f CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
ORIGINAL FILE - YELLOW - INISPECTORffk
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING