20030449.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MS.-j1;t'jvS jorJEC.
MAILING ADDRESS
9 118
CITY ZIP TELEPHONE
Ebmcooz> c18024 a2,5 V5 - 70
NAME
ADDRESS
CITY ZIP
NAME ICBLN
AAA 7,401< SERVic-F- Cc," IA) —,-
ADDRESS
—327 ice r? t<Ljq N3r.-> A*NXLIF—
CITY ZIP TELEPHONE
Kiev-Lwlb 960.3-6 147-16 8o,3 :y
STATE LICENSE NUMBFR EXPIRATION DATE
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PERMIT EXPIRES
USE PERMIT �&)3 ()
ZONE NUMBER
JOB
S ITE1APT#
ADDRESS PL
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PLAT NAMEISUBDIVISION NO.
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LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
AW permit Required
Street Use Parrnit Raq'd
EXISTING — PROPOSED
Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION— FT
Underground
Wirtng required [3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13 z
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I
BY DATE
FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU SHORELINE ORADBI I INSPECTION 1. BOND
REO'D POSTED
OYES ONO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED , PROPOSED
NEW J2- RESIDENTIAL 13 PLUMBING/MECH
LOT COVERAGE
ALLOWED PROPOSED
I E .) PROPOSED SETBACKS (FT.)
FRONT L/Ft SIDE REAR
I
JOR
ADDITION 0 COMMERCIAL COMPLIANCE OR
1:1 CHANCE OF USE
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REMODEL MULTIFAMILY SIGN
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CYDS ( _ _FT)
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REMARKS
DEMOLISH [:] OTHER
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CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
CHECKED BY
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SPECIAL INSPECTION JAHEA
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit
C ity Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORGMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOMAIN (CURBS, SIDEWALKS, DRiVIEVAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: ISO DAYS
CL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICAK 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
MPLOYEES. AND AGENTS FROM ANY A
EDMONDS, WASHINGTON, ITS OFFICIALS, E NO
Fire Inspection
Receipt #
ALL CLAIMS OR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
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Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NO R LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Receipt #
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPFIOVAL
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Oftial or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATI9WjM7rCE_AND RCW 18.27.
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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
FINAL PROJECT "PROVAL FORM
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RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Aels. Jiqmj)s
MAILING ADDRESS
J118 20:rfl)
CITY ZIP TELEPHONE
ftmorotc- 51802A 1 425 V5 - 7
ADDRESg
CITY ZIP ITELEPHONE
NAME CBL#
A A 4 7 5f c v r c - e � Cy .,, IfUt
ADDRESS
—4 *z f< t<(_14 N3fz> h&Nxty—
CITY ZIP . TELEPHONE
VICI(LA031> 9803-6 qZIS 803 :Ya
STATE LICENSE NUMBER EXPIRATION DATE
0AATASC0661M/.0y./8L0,V 1�(
PROPERTY TAX L NO.
le)q �V027` /M M/ 6190
-7
PERMIT ELXPIRES
L
I USE PERMIT
ZONE NUMBER
JOB S TE/APT#.
ADDRESS q11 L.-If27 A =
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
0 NEW
.52-RESIDENTIAL PLUMBING I MECH
ADDITION
11.
A
COMMERCIAL COMPL ANCE OR
0 CHANGE OF USE
REMODEL
ULTIFAMILY
0 SIGN
REPAIR
0 GRADING
CYDS
FENCE
( X FT)
0 DEMOLISH
kw
TANK
OTHER
GARAGE.
RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIV" EXPLAIN'
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
kh4t!�
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
- fAi - f-i pq rj!;. &10 F; tx
HEAT SOURCE I GLA23NO % I LOT SLOPE %
PLM CHECK NO: STED DATE
.. ...... 04 ........... " ............ 0""'o .17 - -
THIS PERM11T AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION. 180 DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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, 98 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 HE
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 THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRE" 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 LABOD CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMERS COMPENSATIOICLItIBYWCE AND RCW` 18.27.
DATE SI NED
4 7:27 3 /.& 3
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESOP Approved
AW Permit ReWired
street U" Palm" PAO
EXISTING PROPOSED
Inspection Required
Sld&wa& Required
REQUIRED DEDICATION— FT
underground
Wir1rigrequirod 13
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
I I
I
YES E3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
REVIEWED BY DATE
FIRE REVIEWED BY DATE 1 011,
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
BOND
I
REQ'D
POSTED
I
13YES 13NO
S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
_XP I
I
,
LOT COVERAGE
"
I It
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
MU
T B XIM
B P S
--MQur UR SIDE REAR
FOK
PARKING i AN 1�
REQ`D I PROVIDED 1
d7flaW qWX"ftW&UflbyVeAPDATE
06
CHECKED BY
OCCUPANT
GROUP
SPECIAL INSPECTION 1AFfEA OCCUPAW
REQUIRED [] YE LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
1
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
R INSPECTION
111110
1,425)
771-0220
EXT 1333
FEE FEE
State Surcharge
A Description
City Surcharge A.,
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Officiall or hWher Deputy: and Fees are paid, and
recelpt Is acknoslodged In space provided.
MQ1)U8/SP_NfURE:, �,j : �ATE
BY
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
..............