20030509.pdfL
__r_
DATE
U--? I I PERMIT EXPIRES -,of#
USE PERMIT
CITY OF EDMONDS ZONE IN 3_0 to,
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS S
OWNER NAMEINAME OF BUSINESS
V�C_ PLAT NAME/SUDDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pern*Jt A red
k kzA P� street Use Psqutt .T
*fm
CITY EXISTING — PROPOSED Inspection Requited
ZIP TELEPHONE Siderwatic Required
6) t_,,\ C, 1 —14) - REQUIRED DEDICATION_ FT underground
Wiring required
NAME METER SIZE LINE SIZE -TO. OF FIXTURES — PRV REQUIRED
ADDRESS REMARKS I YES13 NO 13
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CALL RP_ f=110A (. 4-Vhl t5eMf�A I"
NAME
ow
/ WA�
ADDRESS
CITY
ZIP
VTELEPIjt1NE
STATE LICENSE NUMKER
EXPIRATION DATE I
CHECKED BY
?7R&TAX �Af
[j NEW
RESIDENTIAL
C9
PLUMBING / MECH
ADDITION
COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
[:1 REMODEL
0 APARTMENT
SIGN
REPAIR
[3 GRADING CYDS
FENCE
( _ _ FT)
0 DEMOLISH
TANK
OTHERt)E&r
GARAGE
RETAINING WALL
[3 RENEWAL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR MZ!N:
NUMBER&I
NUMBER OF
CRITICAL
OF
I
WELLING
I
I
AREAS
I
STORIES L9
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
FIRE REVIEWED BY
LU
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
REO'D
I PBOND
OSTED
13YES �<NO
SEPA REVIEW
9_1GN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
5i4 I f
:XP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R§IDE REAR
PARKING
LOT AREA LANNING REVIEWED BY DATE
REO'D I PROVIDED
uwo
REMYRn
CHECKED BY ITYPE OF
SPECIAL INSPEFTORTA
REQUIRED [3YES
REMARKS
PROGRESS INSPEC
C
OCCUPANT
GROUF
OCCUPANT
LOAD
PER UBC 108/FlNAL INSPECTION REO'D
VALLIATION $ 1461,,41:1�
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
.1:21
Building
PLAN CHECK 110;.7 VESTED DATE
Plumbing
( Y—)
0 � —
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
X DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PERMITAPPLICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
4:A- State Surcharge 460
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
DEEMED TO MODIFY, WAVIE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
z
Landscapelnsp.
Receipt #
1 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-
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 official or histher Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSP"SURANCE AND RCW 16.27.
OFFICIALS SIGNATURE DATE
SIGNAT DATE SIGNED
IA95)
%-Vsh.
M 1�41�VUL (--- )/;�r§ 5
11 .16-45's
I �Lj
771-0220
RELEASED BY I E
mommos��
ATTENTION
M 1333
I, 7) /�h
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE ( LOW - IN4ECTOFI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
jYL
G
PINK - OWNER G LD -ASSESSOR
110/011
I
z
0
M
M
M
0
-10
0 C
M M
to
0 -n
,n
M
0
0 M
C
M0
z
z
z
0
M
9
%
N,
'1�4-
9
is
3
0
CITYCOPA VAL
Ay
c
I
RECEIVED
JUN 18 2003
PERMIT COUNTER
�-ZONE
SETBACK&
FR
SSIDE-- C51
m� -
OTHt"
L HEIGHTmmm g24�;
pew -be(-P- APPROVED AS NOTED
T BY ENGINEERING
t) -
#C-W
DECA -", lw� Date:
b 'I
m,
777
PAV ED—.
. 12ivEWAY'
(o / , 'S
.11 -LE FOR
IERICONTRACTOR IS RESK; `,6
EROSION CONTROL AND W-33AGE
AVEMU5
PL)q&i
'Ri Pi"ROVED BY PW
pfkopErry ovjmEe: 7TEFF
'03
7�,
"Z
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-------�
k4,aNGINEEWNG DIVISION DATE.&/� Z
MZASISSMN
PLANNING DIVISION DATE----.
PROJEC
"A
SITE ADDRESS .112 -Y
2 (OaS 5 ADB# .21
PERMIT _______PATE INSPECTED Z
DESCRTTION OF WORK TO BE INSPECTED /-'-NL 6;, (AcrlK
A d to determine final compliance with approved, plans. Final approval
field ' inspection was conducte from the above signed Department to the release, of
dei oii&- that there are , no objections
CE BONDS and the granting of:
ROJECT APPROVAL
GRANT FINAL P
VATH CONDITIONS NOTED
GRAM PROJECT APPROVAL
C) COPY of CONDMONS given to owner/contractor by inspector
�-FAILED FINAL INSPECTION OUTSTANDING ISSUES
given ontractor by inspector.
0 Copy of CORRECTION NOTICE to owner/c
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Si
ocaprvl.doc.l:tenip:bldg:fonnsIO/OI
a
z
9
0
M
:; 9
M
C
M0
0
80
C
-4 C
X M
M z
g) -4
C -Z
Cn
0 -n
n
--i
x
M M
C)
0
0
C
C co
M 0
Z
z
z
9
0
M