20030490.pdfI
DATE RECEIVED 3 sassassass] 1PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP 13ALEPHONE
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NAME
ADDRESS
CITY ZIP
NAME BLO
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER E
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PROPERTY TAX ACCOUNT. PARCEL NO.
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[j NEW 2�r`RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH J;I-IFANK
riGARAGE RETAININGWALL
— CARPORT ROCKERY
UWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF
OF DWELLING
STORIESiAacy- i UNITS
DESCRIBE WORK TO BE DONE
3110 3
USE PERMITa3—
ZONE NUMBER
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.1
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Rw Permit Requ:red
Mat Use Parm I Rsq'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
UndeVouixf
Wiring faquLrod
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES E3 NO E3 Ll
REMARKS
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OWNER/CCINTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
U-6
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
REO'D POSTED
113YEs 13NO $
SEPA REVIEW HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSIED
r-.qF-NT OR
PLUMBING/MECH LOT 0 301
'M TF
TMERUMMI VR" RO
ALLOWED
ECOMPLIANCE OR
] CHANGE OF USE I
PARKING LOT AREA PLANNING REVIEWED BY
SIGN RECID I PROVIDED
rl FENCE
L-i X FT) REMARKS
0 FIRE SPRINKLER
FIRE ALARM I
CRITICAL
AREAS
NUMBER
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPEMY ONLX ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: ISO DAYS
PERMIT UMM 1 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 NOT 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 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-
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' COMPENSAT NCE AND RCW 18.27.
I'S
SIGNMIAE (OWNER ORjk9tN& DATE §IGNED
ATTENTION Off 1333
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
) SETBACKS (Fr.)
UR SIDE REAR
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DATE I
416
CHECKED BY ION C
OCCUPANT
GRO a_
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 11108/FINAL INSPECTION REG'D
$ E
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 #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This applicatIon Is not a permit until signed by the
CALL Building otocial or blether Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
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771-0220 RELEASED BY LV' L.-Il 6ATFJ
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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OF INSPECTIONS
RECORD
INSPECTOR DATE APPROVED
SETBACKS ..... ...............
FOUNDATION:
Footing......................
wall..........................
Pier/Porch
.................
Retaining Wall .......
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'Slab Insulation ..........
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.. . . .......
Elm
M,
PLUMBING:
Underground
-RoUg 4n:.; ......... ....... ;
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Commerc nal
M
......
0
:HEATING:
GasTest.................
GAs'PIpIn6*l'-'
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............
Equipment .............
Co
C i'(FI1
ommerc a nal
EXTERIOR SHEATHING
NAILING. .........................
Mi
ORA NG;
.................
rn
FIRST FLOOR FRAMING...
INSULATION ......
iu
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Floorinsiulat n:.11...
Wall Inctij
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
M,- D a ,, 1-/'j A 4 " /-
MAILING ADDRESS
/61 Z) -3
CITY ZIP 17LEPHONE
[qzc� -7-7 e - -7q q-
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NAME
ADDRESS
CITY ZIP
TELEPHONE
NAM�O_C tee,
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ea. J
BL#
ADDRESS
114114,
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CITY ZIP
TELEPHONE
0.314, 1 +' 9671ir
1 47 s'--lTr
STATE LICENSE NUMBER
EXPIRATION DATE
CHE X E
GLAr- —Arwstosc.-i
4V3110 .3
PROPERTY TAX ACCOUNT PARCEL NO.
00q18f3 0000,3 :3-000
NEW
arRESIDENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MUL11FAMILY
0 SIGN
[3 REPAIR
0 GRADING CYDS
FENCE X FT)
DEMOLISH
4j;t-TANK
GARAGE
CARPORT
o RETAININGWALL
ROC RY
cl FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUS44ESS OR ACTlVTM EXPLAIN:
NUMBER IUMBER OF CRITICAL
OF IWELLING AREAS
STORIES tWLINITS NUMBER
DESCRIBE WORK TO BE DONE
CL f.\/ 0 x ka c, � t
'. 4, 11 e s
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
2 /_ i�C
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO. I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
RN Permit RaWked
Street Uss Permit ROO
EXISTING - PROPOSED
InspectIonPaquired
swNIARScipw
REQUIRED DEDICATION- FT
Undergrmand
WWmg required 13
METER SIZE
LINE SIZ
OF FIXTURES
PRV REQUIRED
YES t3':
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE -
ENGINEERING REVIEWED BY DAtE
FIRE REVIEWED BY DATE.*
U11
VARIANCE OR CU
SHORELINEORAD1111
INSPECTION
BOND
REQ'D
POSTED
13YEs I3NO1j
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSEDLALLOWED
PROPOSED
EXP
,
LOT COVERAGE
REQUIR 8
PDIX
POPOSED SETBACKS (FT)
I
90 NT LIR SIDE REAR
ALLOWED PROPOSED
FR
EQR
'Vi"'T Rr- PAP
PARKING
REQPD PROVIDEO,
MFLMMI 'OR CAP
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REMARKS
CHECKED BY
GROUP
SPECIAL INSPECTION
REQUIRED
JAREA
ULAXF.A141
LOAD
REMARKS
RESS INSPECTIONS PER UBC 108/FiNAL INSPECTION RE=
HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOKE ON PRIVATC PROPERTY ONLI ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALXS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPUCATIOW ISO DAYS
PERMIT ILIUM I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE 13ACK OF PINK PERMrr FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIF% DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, " 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 MODIF% WAIVE OR REOUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY,$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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-
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
WORKMENS COMPENSAM CE AND RCW 18.27.
'f.
SIGMTLP(E (OWNER OR Aq*TL I DATE �IGNED
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
State Surcharge
--0'1CIty Surcharge T4T 7___
Fire Review Plan Chk. Deposit
Fire Inspection I'S ,-e Receipt #
Landscapainsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
CALL
This applIc"on Is not a permit until signed by the
Building Offidal or his/her Deputy: and roes are paild. and
FOR INSPECTION.
receipt Is ackwMedged In space provided.
RE
mrlgA DATE
I ow"/
1A10
%425)
771-0220
RELEASED BY ___4ATEf
ATTENTION bx-u I a
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
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