20030454.pdf(71 N1 4-
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW*R NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
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ADDRESS
CITY ZIP TELEPHONE
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LPERMIT EXPIRES jam./
USE PERMIT
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NUMBER
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JOB
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ADDRESS 7
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PLAT NAME/SUBDIVISION NO
LOT N
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STRE
TESCP APP(Ov9d
AW Perffdt Required
W 1
74 1
Street Use Permit RI'd
EXISTING — PROPOSED
inspection Required
SIdew Ik Required
REQUIRED DEDICATION 2-0
FT —
Undef"round
WiringroquIred
mETE7 SIZE
LINE SITE
0 XTURES
PRV REQUIRED
0
it
TNO.
YES)o NO 13
REMARKS
z
OWNERICONTRACTOR RESPONSIBLE
FOR EROSION CONTROLIDRAINAGE
I
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1 TY TELEPHONE 4-- M
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T91—USIDENTIAL PLUMBING/MECH
ADDITION
COMPLIANCE OR
COMMERCIAL CHANGE OF USE
REMODEL
MULTIFAMILY SIGN
REPAIR
G CYDS
FENCE X FT)
DEMOLISH
[3 TANK
OTHER
E]
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
MPE OF USE, BUSWR"R ArTIVITYI-EXPLAIN-
NUMBER
NUMBER OF
CRITICAL It &V
OF
DWELLING
AREAS
W
STORIES
UNITS
NUMBER/ey
DESCRIBE WORK TO BE DONE IF.
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7_15�f !E> r7
% — I LOT SLOPE %
PLAN CMIP
ANO*
THIS PERMIT AUTHORIZES ONLY 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.
PFRMITAPPUCATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK 15 STARTED WITHIN ISO 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 C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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-
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 SRW,,ENSATION INSURANCE AND RCW 18.27.
SIGNATURE j*fNE0 9DIAGENT) FDATE SIGNED
a)FIAkLo-
ENGINEERING REVIEWED BY DAT
1� - C-2 I W%AL is 11, 1 0---s
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADBI
INSPECTION
BOND
REO'D
I
POSTED
I
13YES
9wo—
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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ID
,
2 0
I 24 j
EXP
LS
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
,5
5 7%
7-; 7,5* 1!5
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7. 5 44 F:
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
116
REQ`D ED
PROVID
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REMARKS
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A040 U
CHECKED BY ITYPE OF = LICTION CQDE OCCUPANT
-DZI #7 GROUP 93 U_
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES 5- LOAD
sr
REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REG'D
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Zj n,
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
OWN.
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
APPLICATION APPROVAL
Th s application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
Acelpt Is acknowledged in space provided.
PI RE TE
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771.,0220 _Itetft�D',B ATE.
Y/j
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL _ry I fl/ A1111"
(" v I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- �RIGII�Al_ * FI E YELL INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWN GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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APPROVED AS NOTED
B�F ENGMEERING — — — — — — — — -
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FLAT Place S.LU. (ki
y.lk RECEIVED
Plan APR - 8 2003
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Ltjydl UUtiUMPLIUH rlfdlyf I L LIUH
LOT 2. -4"BOU" 64OW ?%AT '354-vo
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CMACK
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Lot Coverage Calculation MAXIMM wRIGmT a6**W
LOT AWSA 8mo &=Aws Pier
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LOT COVKRAW AS A MRCINTAOIR 00 LOT AMA -;0;4% cOry
"AX"." APPROVED BY PLANNING
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CITY OF EDMONDS
121 5TH AVENUE NORTH * EDMONDS, WA 98020 - (425) 771-0220 o FAX (425) 771-0221
Website: wwdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
August 13, 2003
GARY HAAKENSON
MAYOR
Leif Helleren
Helleren Development
P.O. Box 1764
Edmonds, WA 98020
RE: 9609 — 215'b PI SW address Lot 2 of S-02-204
After reviewing the permit we issued on 6/24/03 it was discovered that the incorrect
address was given to the permit for Lot 2 (Permit # 2003-0454). The correct address for
Lot 2 of the Hazel Davis short plat should be 9607 — 2151b pl SW.
ed
I am including a copy of the Short Plat map showing the lot numbers and assign
addresses for each lot. We have changed the address on the face of the permit for lot 2 to
reflect the correct address of 9607 — 215'b PI SW.
If you have any questions please don't hesitate to contact me at 425-771-0220.
Sincerely,
There!a2 umbau
Permit Specialist
cc: Short Plat Map
Incorporated August 11, 1890 0
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