20030462.pdfI
[PERMITEXPIRES IZ"I'�LbR
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DATE RECEIVED
CITY OF EDMONDS
USE PERMIT Z
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS,2 ?SO'7 q 944 PL
OWNER NAMENAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
(AhO !%La:k dy LID FEE $
AV-
1 tSCP Approved
PUBLIC RIGHT OF WAI PER 0 L STREET MAP RW Permit squired
street Use PR emth Req'd
CITY ZIP TELEPHONE
EXISTING — PROPOSED Inspection Required
Side*411c Required
I/ Z_S�_ 314 1
Underground
REQUIRED DEDICATION— FT — Wiringisquired 13
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
18ukr�lrus
YESC3 NO 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE
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NAME CBLN
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ENGINEERING REVIEWED BY DfTE
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ADDRESS
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116 U/
FIRE REVIEWED BY SATE
CITY ZIP TELEPHONE
VARIANCE OR CLI SHORELINE OR ADS# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE C BY
REO'D _S
_�O_TED
13Y ES WO S
11 C-0 C 1 9, 9- 111
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY ARC
P EL�NO,
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP , ,
PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW ESIDENTIAL FRONT SIDE REAR FRONT LIASIDE REAR
ALLOWED PROPOSED
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
IVA
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN
REO'D I PROVIDED
(0/5-
5�45:t_?`*K�w AR
REPAIR GRADING CYDS X 400P FT)
REMARKS
DEMOLISH TANK [3 OTHER
GARAGE RETAINING WALL 0 FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
KEMP
(TYPE OF USE. BUSINESS OR ACTIVIIM EXPLAIN:
OCC N
CHECKED By U
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tV GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION OCCUPANT
STORIES 02- UNITS NUMBER
JAREA
LOAD
REQUIRED [3 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REO'D
Ceodoee P�t Feblit
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORCM6 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ON THE PUBLIC
III: 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERmrTAPPucATioN: icoDAYS
CL PERMIT UMM I YEARI - 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
2 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
Landscapeinsp. Total Amt. Due
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
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Recording Fee Receipt # 7_ZZK�
IL
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-
This application Is not a permit until signed by the
CALL
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
6 let or his/her Deputy: and Fees are paid, and
FOR INSPECTION �Ml Is acknowledged In a . pace provided.
WORKMEN'S COMPENSA��URANCE AND RCW 18.27.
SIjGTURE DAirp
SIG RE (OWNER 0 DATE SIGNED
1A9
1425
771-0220 ATE
Y
ATT9NT19fl
Off 1333 3
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI- ORIGINAL - FILE NSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
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DATEO
RECORD OF INSPECTIONS
SETBACKS .....................
FOUNDATION:
Footing......................
Wall .....................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
-inRough ...................
Commercial Final ......
-HEATING:
GasTest ....................
Gas PI p Ing .................
Equipment ..... ...... ......
Commercial Final ........
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
I
DATE RECEIVED 12.
�21'7_2 EXPIRES
PERMIT
U6E
PERMIT
CITY OF EDMONDS ZONE P NUMBER )Lt
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS ?sC) .2
cf9" PL I,.�
OWNER NAMEINAME OF BUSINESS 2
LI*" C-C) 1%." 4:5 e�, PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
1,4/ LID FEE S
15 MAILING ADDRESS L" S4
-C
PUBLIC RIGHT OF PER OFFICIAL STREET MAP Jw! P:=Dd
-LAl :treat Use Parmlt Rsq'd
CITY ZIP ITELEPHONE EXISTING — PROPOSED Inspection Required
Sidewalk Required
UWarground
REQUIRED DEDICATION— Fr WWg required 13
E-v-o -f e- +f
NAME METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
YES13 NO C3
Adeo Llcwle< J�S�V- V U� REMARKS I
ADDRESS OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
//g/r/ - el-" &,Lc (A/
CITY ZIP TELEPH NE ---
[ - , V,:, f e., 11, 1 1�cll(? 316 -oz C (
NAME CBLN
I
e7 /Ij _74 �Ilc ENGINEERING REVIEWED BY DfTE
ADDRESS 2g L67—
FIRE REVIEWED BY 13ATE
CITY ZIP TELEPHONE M
E il,- , _ f / -ft?e_41 I 4/71;�_ VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE B -.—NO REO'D I _.=TED
tlil(f c? SEPA REVIEW SIGN AREA 113YEq R*- s HEIGHT
PROPERTY COMPLETE , EXEMPT ALLOWED D ALLOWE ED
4e�� PAR EL-N . (
C 0 PROPOSE D
0
V0, PROPOS
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
NEW RESIDENTIAL PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR IVA
ADDITION COMMERCIAL CHANGE OF USE
AR�
MODEL -npAm SIGN PARKING LOT 7JPLANNING REVIEWED BY DATE
RE MUL ILY REO'D I PROVIDED
rj GRADING rZp4'EN AIC, 4
REPAIR CYDS Lzj ( ?, X -FI) REMARKS
0 OTHER
0 DEMOLISH TANK
0 GARAGE RETAININGWALL F RE SPRINKLER
CARPORT ROCKERY 1:1 FIRE ALARM
UWE OF USE, BUSINESS OR A�7#11-Y) EXPLAIN: CHECKED BY ITYP=ON CUPANT
Do
Te �, , . 4 1 GROUP
NUMBER N EER OF CRITICZL
OF (�2 D U%M!L I N G AREAS SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES
STORIES UNITS NUMBER09- LOAD
DESCRIBE WORK TO BE DONE
REMARKS &Ujlt",1111�11100AAS AMOnk!
PROGRESS INS 9%1A7WjF1F%Pf9 CTION REQ'O
0 1- V- 95P l"
VALUATION
$
Deacription FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
_VLA_N CHECK NO: Plumbing
VESTED DATE
0.:3
Mechanical
THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
h 13E DONE ON PRIVATE PROPERTV ONIX AM CONMIRUCTION ON THE PUBLIC Grading
23 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STAFITIED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICAUL ON WHALF 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
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'$ ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee It #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRE" AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This applicallon Is not a permit unfil signed by the
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Bui his/her DePutY: and Fees are paid, and
N r
/=Ial or
r
IN VIOLATION OF THE LABOR -CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIO r t Is acknowledged "co P,!ged.
WORKMENS COMPENSAT SIGYATURE
,P"URANCE AND RCW 18.27. DATEI
11!�N GENT) DATE SIGNED 1'.5
rRE (OWNER
17— (,3
771-0220 Y DATE
ATTENTION M 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
GREEN - ACCOUNTING
04/02
PRESS HARD -YOU ARE MAKING 5 COPIES