20030418.pdfI
DATE RECEIY�a
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
.2�R �INAME OF BUSINESS STOLF— 13VILP14C,
BE!�E 4—rOLE C-ornom-xv
MAILING ADDRESS
(37o4i- a-L CF- 15W
CITY ZIP 17 LEPHONE
ADDRESS
NAME
12v c) —I/.
ADDRESS
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CITY
STATE LICENSE NUMBER
ZIP
ZIP I TELEPHONE
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPA YR9Urf-_
0 GRADING CYDS
DEMOLISH
0 TANK
GARAGE
-1 RETAINING WALL
13
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVTM EXPLAIN:
NUMBER
MBER OF
OF
DWELLING
TV,
STORIES
UNITS
DESCRIBE WORK TO BE DONE
W
%4\
CBL N
3
_00
PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
[3
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES //7/- 3 1-4?
USE PERMIT
ZONE NUMBER 2W-2-.0-04146
JOB SUITE/APT#
ADDRESS 6 1 C)
)Z
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
7
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP
RW Perffo =ad
Street Use Pennit R"d
EXISTING — PROPOSED
In3pection Required 13
Sidewalk Required 13
REQUIRED DEDICATION— FT
Undergmund
Wiringrequirod
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES 13 NO 13
REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
16
VARIANCE OR CLI
SHORELINE OR ADB#
INSPECTION
I
RE011-
I
PBOND
OSTED
.__
Oyris;15w
s
BEIRA REVIEW
SIGN AREA
HEIGHT
COMPLETE- EXEMPT
ALLOWED I PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
L
z
PARKING
REO`D I PROVID ED
LOT AREA
ING REVIEWED BY DATE
6 /th
IL
t,
-AI
CHECKED BY
CTION
9M��
OCCUPANT
lim
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ORO
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CRITICAL
AREAS
SPECIAL INSPECTION
OCCUPANT
NUMBER 1Y.4
REQUIRED [:] YES
JAREA
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
1 k-r--
VAI I IATInM
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
L124�2Z I Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
3
Grading
M DOMAIN (CURBS, SIDEWALKS, OnIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMrTAPPUCATION: ISO DAYS
IL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERNIff 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
C
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
Landscapeinsp.
Total Amt. Due
0 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
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
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknoyAodged In spice rAovidod.
WORKMENT COMPENSATION I NCE AND RCW 18.27.
N*W-
TE
--- -
BIG OW ER 0 G
DATE SIPNED
5)
OFFICIALS SIGNATURE
771-0220
IVATE
RELEASED BY
AITWITION
M 1333
& hl�o
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-OWNEFI - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
0
t
DATE RECE3
DATE REC
LPERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB Vdurr
ADDRESS
OWNE IAMPNAME OF BUSINESS 5—roLE MVILPYnc,
Srezr 15�7_ C.,;,r1)?4t4V
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
)3LOC K 9-1 LID FEE $
C3 7 o 4- �3,7_ Pi- A ce 5k/
TESGP Aps=
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW pamlit
Street Use Permit Req'd
CITY ZIP LEP E
EXISTING — PROPOSED Inspection Required
SidewsA Required
M-77e- 14)_!�-
Underoround
REQUIRED DEDICATION— FT — Wimo requirsti
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
I
z
E ADDRESS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
T
:CITY ZIP TELEPHONE
NAME BL#
G4 34
ENGINEERING REVIEWED BY DATE
It
ADDRESS
T,23- 33 -7 0
DATE
FIRE REVIEWED BY
cc
CITY ZIP , - '' I TELEPHONE
IC
VARIANCE OR CLI SHORELINEORADBO INSPECTION BOND
frATE Ll.�JSE NUMBER EXPIRATION TE Lo"CHECKED 0
RE%NO POSTED
OYES No S
S
HEIGHT
PROPERTY TAX Arco,, eARCEL NO.
SEPA REVIEW SIGN AREA
EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
00 ±M& 05 20C> '_30 0
EXP
NEW RESIDENTIAL PLUMBING MECH
A
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMPIL CE OR
ADDITIA COMMERCIAL 1:11" IAN
dHANGEOFUSE
REMODEL MULTIFAMILY SIGN
PARKING Lar AREA P ING REVIEWED By DATE
RECID I PROv(10'ED
h/v
FENCE
GRADING Cy6s X FT)
REMARKS
DEMOLISH r] TANK OTHER,,
PO RETAININGWALL af RE SPRINKLER
o GARAGE
'CAR FIT ROCKERY FIRE ALARM
UWE OF USE. BUSINESS OR ACTIVITY )'EXPLAIN:
fC E tA I L,
CCUPANT
CON' G
CHECKED By J)N _1ZOUP
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
OCCUPANT
SPECIAL INSPECTION AREA LOAD
STORIES UNITS NUMBER
REQUIRED
DESCRIBE WORK TO BE'DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-O..
-Z
pump wi7m w -raAHF_ -Itl�PN
"FIN ?v M P., \\L) K rz; F-viz- L) Kc ell
VALUAnON Hui
"B49crlptlon
F
Descripillon
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % -'Lcrr SLOPE %
Building Permit,, City Surcharge
PLAN CHECK N 1 0: VESTED DATE
Plum I
anical
THIS PERMIT AUTHORUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE . ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Ea
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL R UIRE
SEPARATE PERMISSION."
__.i
Engr. Review
PERMIT APPLICATION: 1W
PERMIT LIMIr I YEAR - PROVIDED WORK 15 D WITHINA96AYS
Engr. inspection
SEE BACK OF PINK PERMIT FOR MOR 1 F9x9ATr0N
OR HER SPOU
"APPLICANT, ON BEHALF OF Sk'HEIRS, ASSIGNS AND succEsofts
CITY OF
re Revievy Plan Ch�-.0epiosft
Fi I
IXS
IN INTEREST. AGREES TO EMNI", DEFEND AND HOLD HARMLESS THE
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Mire inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERFAIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due I
13EEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
--II
21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee R
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
ap
THE OWNER. I AGREE TO COMPLY WITH CRY AND STATE LAWS REGULATING CONSTRUC-
H'
This application is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
10
OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknovdodged In sp Idad.
FOR INSPECTION pce gTov
IN VIOLATION
LTIN
_#4,MNCE AND RCW 18.27,
WORKMENS COMPENSATI010
OFFICIALS SIGNATURE ATE
St ER ORXbENU,-' DATE SIGNED
SIG
179-5) -
771-0-220 -RELEASED bATE
BY
ATTENTION
M 1333 -D,<
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ---6-
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