20030486.pdf13
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS Y
MAIL' ADDRESS./ ' . y
/R/" z, 5- es 1-1- lw6:
CjFTy0/,.n ZIP TEL HONE.
&.)2� 1_7 _ 4
ovilif.s I <
ADDRESS
CITY _1&P_ ITELEPHONE
NAME — I CBL
ADDRESS
_�:;&7eoo —f11Vr17,0ve6
CITY TELEPHONE
.41!!!2
!g / ZIP I *12� vlf 1�11,
tw.ma� 77 'zo(o
STATE LICENSE NUMBER EXPIRATIOJN DATE I 26ECKED nv�
6(4) 1z L(Vz4_0zf1t
P110PERTY TAX AcCPUNT PARCEL NO. _:z
00"73Wo 60S!2Q/-fA
NEW RESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
0 REMODEL MULTIFAMILY SIGN
REPAIR GRADING CYDS 0 FENCE X
( FT)
DEMOLISH TANK OTHER
GARAGE o RETAINING WALL o FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACPA% �_
NUMBER I NUMBER OFv CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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.
PERMIT APPLICATION: 11150DAYS
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. 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 P40T BE
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 HERE13Y 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 L&Beff'MDE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENWON INSUhl1kNCE AND RCW 18.27.
DATE SIGNED
-1, -7.6
PERMIT EXPIRES I Frj_u
USE PERMIT
ZONE NUMBER
J013 UITE/APT#
ADDRESS Z
A&C
MEN
PLAT NAME/SUBDIVISION NO LID NO.
77 LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Per" Required
Street Use Permit R6q'd
EXISTING — PROPOSED inspection Required
S ewalk Required
REQUIRED DEDICATION— FT U=
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURE PRII REQUIRED
I I I YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
DATE
I
FIRE REVIEWED BY DATE Lu
,ft.— I IM,
BOND
POSTED
SEPA REVIEW' 4 1 Of" U I A IMMMMPIW94111 HWUHI
olilvi
E—P
I
COMPLETE - EXEMPT Iftilibl. 90 LLOWED . PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ`D I PROVIDED I I
REMARKS
CHECKED BY ITYPE rA 0 fn OCCUPANT k;�
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS
PROGRESS INSPECnONS PER UHC 1106/111FINAL INSPECTION REO'D
VALUATION
L
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt, #
A PLICATIONAiPROVAL
CALL
I sa Icallon is not a permit until signed by the
ktIsacknowled
a lidin IcIal or histhe 0 ut d Foos are paid, and
W
FOR INSPECTION ec Ip dinspecopSqvided.
F LS ATUR �Qff E
771-0220
R FAtED BY JbATE
EXT 1333
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
1
a
1 0
I
If
4
too till Wool
"pq
do
food
it
! 14
A RECORD OF INSPECTIONS
I k I
I If- I d,
INSPECTOR DATE APPROVED
Its
Id
If
If
SE4ACA
I I so 0 0
3,
If I I
I did 1. Id, t:;f
If, FOUNDAIION�!-* I Id did; ee
It 1, 0'. if .1 off; It,
61 wfo� If I. Coll
0,tdd. -11
do to It
Footing easoo-wee a 0 9 a 8 0 0 6 0 0
6
1 0 Iz I I I I do I If I I I .......
rd 10
I, If
If I
da Wall I I I
I'd 94 1 r
I'd I I L I t
If I . 11 1 1
d-
If
d: I
PlIer/061c h
dol
f Retaining WOM
If I, o If I I I If. I If
.14 1 Id'? I
I I'd t " t I, Id 1 1 If
. I I , I
do It I
I OIL I I. p do ',I
f Slab Insulation *Settle***
;I L'4"" If 46 1 Jet I�Ir
d7l"
If I I. 1 1,
e. .1 4 0 did If
- I I
of 1 4 1 Ild I:, I
IV tL I I I I I I . - "
of I , I oV
I 'PLUMBING* I . "d, I,.
dr :I, :1 14
If
f CIA
I'd If of Underground If f If.
4
I I If I do I do
1. 1 dr,— do
If I do t 'I
I I ol.l
fo
'If I too Iq4 I
It, Roughwin &eI I I I I'd 11 of
. I I I I
do
.41 1 1 1 1 1
5L I; I ' I I . I
Final
Commercial
I I d: 1,
If
I did I ot
.. of
off,
HEATING:
I r If
lod I, r, I 1 :1 1 1 1 1 . I I I I
- I 4vI I I I
Id. I a Te I' d I Idtil
If. I I.; ...Id III - I I I
I L, fId' I . I. I " I. I St I If I
If
I, If
I
1. 1. od I
;II 'd
If 0461*889 664 *ease 6*0*
. If
P
I GasLoj If I I'd It
If I,,- p ng
d dd
If I I I 'LdddL�,,
I I I. -Id',todd
If I * I fled
I PL I I I. I I r I of"
I I ro
d, I I I Id ddr I
4 'IdIL: Equipment
-d Commercial Final'
Id'
4 + 'I
If! 1 1 HING I I I
EXTERIOR SHEAT
I I I If
11 I'd III I It, I I Idd,j NAILING
4
l+
d:
1, 4 1 1 0 1 1 1 1 1 1 1 Id I
dr., If FRAMING 000 *@Volpe 4 1, d
I. I lot a d—d: l I If 'I . I I If I i,
P
4 If I + +
FIRST FLOOR FRAMING866 I d
+
If r + 'k
IP I If
I. dd I INSULATION 1 6 4 a 0 0 6 0 9 0 0 9 0 a 0 6 a be@ I I I I LA
Id
+
I I. did It I Floor Insulation
4 1 .
+
4 1 1 1 1 + I
Wall Insulation
.I,)I r did I . I r'- , 1 -1
+ I +
6 1
+1 � I : r, I I 1 0 . I I
+ 0
'Celling IhWat
III rr I I I dot too*@&*
.1% fit I
4
SHEETROCK NAILING
+
SPECIAL INSPECTION .80
food
If
If
4
#646006000
MISCELLANEOUS dd
It
Amom 44o� I I I
f r," I w If I FINAL APPROVAL FOR
It 1 OCCUPANCY
+
Oq
+
of w
did
it
I'd
I
r
+
+ +
dd�' III Id
dd IddIddIdd- off.
+
e
dd,
%do,
of
ho
If
, If
0 1
P. 410,11
It.
0
M
"T
tow
rn
lot
4
0
C Pod
Iq
10
C
it
14
to
4
no
Idd
IN
4C
PI
4
little I
C)
M
L
i
Lpg�IVIIT EXPIRES
USE PEIRMiT
ZONE
CITY OF EDMONDS
NUMBERIA3
CONSTRUCTION PERMIT APPLICATION
JOB UITE/APT#
ADDRESS 'OAWC,�,f
1017,5681
OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
MAII G ADDRESS./
m
LID FEE S
MOP Appvvod
es e-w-)
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP WN Pefffift Requked
U" P*fMN RWd
CITY Z)P ITELEPHONE
* 7
'8� — I- —
I Susid
EXISTING PROPOSED InspecOon Fleq*ld
61dM3* ReWired
Urdo�
.. REQUIRED DEDICATION FT WWOF*quw
METER SIZE LINE SIZE NO. OF FIXTURES PHV REQUIRED
yps C3 NO E3
ADDRESS
REMARKS
OWNERIC6NTRACTOR RESPONSIBLE FOR EROSION CONTROUMRAIMAGE"i
07
CITY HE
#%-AD nanr
NAME L#
n nu orrm-mai
AEOWt Uy-'Utt "it
ENGINEERINGT"W
cc
ADDRESS
NFIDAVUS NALL NOT
HE
FIRE REVIEWED BY EFffrE DATE
CITY ZIP TELEPHONE
VARIANCE OR CU SHORELINEORADSN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE KED 0 REO'D POSTED
g?o
13YEs 13NO s
PROPERTY TAX ACQO PARCEL NO.
SI HEIGHT
BE GN AREA
COMP IEPA E x _&UQAE_DPROPOSED
-4nt
eDC)13�& 6022Qz1/_)_7
IType B or' L conni ctom
EXP
NEW RESIDENTIAL PLUMBING MECH
LOT
)T
I
ALLOWED FRONT 48P
ADDITION 0 COMMERCIAL COMPLIANCE OR
El CHANGE OF USE
438cm urvic
REMODEL mummmy SIGN
PARKING
REO'D PRO
06
I
GRADING FENCE
0 REPAIR CYDS X
FT) REMARKS
0 OTHER
0 DEMOLISH TANK
bo I-Inkf
oGARAGE RETAININGWALL cl FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
UWE OF USE. BUSINESS OR AC!3rr!
CHECKE 1) BY TYPE F ON OCCUPANT
GROUP
?_rr K
NUMBER NWUMBEIR OFO I CRITICAL
ELL No
OF D AREAS
SPECIAL INSPECTION JAREA OCCUPANT
STORIES UNITS NUMBER
REQUIRED LOAD
V,
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQU
TV_f 'n 0 ce
VALUATION
Z6
Description
FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUMRIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DOME ON PRIVATE PROPERTY OHM AM CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURB% SIDEWALKS, DRMVAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATIOW ISODAYS
PERMIT L1Mrr I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE 13ACK OF PINK PEnMrr Fon moRE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS A146SUCCESOR8
Fire Reviow
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Flre Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
Landscapeinsp.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OnDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
I HEREBY 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-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
B
IN VIOLATION OF THE L&S8fl-CQDE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMENS COMPEN�KnONINSUIVNCE AND RCW 18.27.
F
JR
RE ER A �AGENT) DAT E SIGNED
5)
_7,
771-0220
Description
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
JCATION AP AROVALL
ation is not a permit until signed by the
or=O'Do ' and F"s are paid. and
_p ppvIded
I.. WaVly�spac -
IED BY fUAIC
NTION EXT 133%1
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- INSPECTOYY�
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
I =
z
0
I
0
M
M
C
M
0
80
C
5� K
M
10
Z
A
o -n
M M
0 6)
0
0 Fn
C2
C
MO
CA
z
0
M