20030510.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
D 01, okon
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
NAME
PC
ADDRESS
P0 90)c '71,
CITY
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STATE LICENSE NUMBER
ZIP TELEPHONE
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LLC, 1 6
ZIP I TELEPHONE
0 NEW
RESIDENTIAL
0 ADDITION
COMMERCIAL
1:1 REMODEL
MULnFAMIl.Y
GRADING CYDS
,,X—REPAIR
DEMOLISH
TANK
GARAGE
CARPORT
[3 RETAINING WALL
ROCKERY
(TYPE OF USE, BUISINr
legIVIM
A
NUjjeER7W/
OF r'6�
NUMBER OF
DWELLING
STORIES'_' 45V45j_
UNITS
DESCRIBE WORK TO BE DONE
LPERIMIT EXPIRES
I USE PERMIT
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NUMBERC>dp�
JOB
SUITF/APT#
ADDRESS
A
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
TEMCP APP(Ov9d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Psn"It Raquifed
EXISTING — PROPOSED
ace
stroot Use Parmh R d
inspeewn Floquirod
Sidmalk Required
REQUIRED DEDICATION— FT
Underw-ml
Wiring roquLred 13
METER SIZE
LINE SI
RES
PRV REQUIRED
ESE3 NO E3
REMARKS
RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
OWNER/CONTRACTOR
DATE
DATE
FIRE REVIEWED BY
I x
- — UHtUNt: OR ADBN !NSPEC i0jN BOND
-0018,0 VARIANCE OR CU I , T' POSTED
I CMECKED Y REQ'D No $
n '8
'[3YEs ONO $
F HEIGHT
SEPA REVIEW SIGN AREA
COMPLETE . EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR z
CHANGE OF USE --- - I
PARKING LOT AREA I PLANNING REVIEWED By DATE
SIGN REOD I PROVIDED
o FENCE
( _ X_FT) REMARKS
OTHER
[3 FIRE SPRINKLER
FIRE ALARM I
CHECKED By ITYPE OF F.ONITR P N
I'M I GR P
CRITICAL SPECTION AMA OCCUPANWT
AREAS SPECIAL IN JLOAD
.NUMBER 191A I REQUIRED [3 W I
HEAT SOURCE J - GLA23NG % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORMES 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.) VALL REQUIRE
SEPARATE PERMISSION -
PERMIT APPLICATIOW 160 DAYS
PERMIT LIMM 1 yEAn. PROVIDED WORK IS STARTED WITHIN 160 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 CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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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 T11 ERSON WILL BE EMPLOYED
L O� "Z P'
Co STATE OF SHINGTON RELATING TO
IN VIOLATION OF THE L:AABOR CO
tW CE AND RCW 18
WORKMENS COMPENSATIO CE AND RCW 18
DATE SIGNED
REMARKS I
PROGRESS INSPECTIONS PER USC 1108/FINAL INSPECTION REa 9
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$
Description Description FEE
' F�FE�E
Plan Check
State Surcharge
Building Permit
City Surcharge L
Plumbing
Mechanical
Grading
---------
Engr. Review
Engr. Ins !on
Fire Review
Plan Clik. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt # _
APPLICATION APPROVAL
CALL
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This application Is not a permit until signed by th
Building Officiall or his/her Deputy: and Fees are Paid. and
FOR INSPECTION
receipt Is acknowledged in space provided.
LS SIqN#URE DATE
11125)
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771-0220
—REL-E A-S-Ed 'BY D
EXT 1333
G OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDIN
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLON- INSPECTOR
PINK - OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 GREEN -'ACCOUNTING
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PERMIT EXPIRES
CITY OF EDMONDS
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PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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SUITE/APT#
AW
OWNER NAMEINAME OF BUSINESS
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PLAT NAME/SUBDIVISION
NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE $
9-�,
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PenrAt Required
S"m Use Peffnk Roo
CITY ZIP TELEPHONE
EXISTING — PROPOSED— ln� Required
Sidewast Required
Liag �
REQUIRED DEDICATION—
FT nderWound
ring required
NAME
METER SIZE LINE SIZE j-'Z, OF FIXTURES PRV REQUIRED
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YES 13 NO C3
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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C17Y ZIP TELEPHONE
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ENGINEERING REVIEWED BY
DATE
ADDRESS
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CITY ZIP TELEPHONE
FIRE REVIEWED BY
DATE
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE REaD POSTED
MY
OYES 13NO S
SEPA REVIE W
SIGN AREA HEIGHT
PROPERTYJAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PROPOSED ALL OWED PROPOSED
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L
,
EXP
NEW RESIDENTIAL KPLUMBING/MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT URSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
I
CHANGE OF USE
REMODEL 1:3 MULTIFAMILY 0 SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ1D I PROVIDED
GRADING FENCE
REPAIR CYDS FT)
REMARKS
I DEMOLISH TANK OTHER
oGARAGE [3 RETAINING WALL [:3 FIRE SPRINKLER
CARPORT ROCKERY. FIRE ALARM
(ME OF USE. BUISINFairdbR ACTIVITY)i EXPLAIN:
CHECKED BY ITYPE OF CO,)NT OCCUPANVT
44RCTION
Z GROUP
Z_
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
0
-
I —
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
STORIEV_ &/4�� NUMBER
REQUIRED [:] YES
DESCA18E WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D.
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VALUAnON
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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 PERMff ALITHORMES ONLY THE WORK NOTED. THIS PEJRMff COVERS WORK TO
t: GE DONE ON PFUVATE PROPEFM ONLY. ANY CONSTRUCInON ON THE PUBLIC
Grading
D0hWN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERUISSIONL
Engr. ReView
PFRMrrAPPUCATION: IGGDAYS
PERMff LIMPI! 11 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due Z/.a
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CnY8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Recelpt#fjf24
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION A PROVAL
GIVEN IS CORRECr 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 appikation Is not a pem* until signed by the
TION; AND IN DOING THE WORK AUTHORIZED Tn"ff1:jA1EEB!y"-W PERSON WILL BE EMPLOYED
BuiLdIng OfIlcial or hWftt Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR C9W_Qf-M1ffSTATE OF SHINGTON RELATING TO
!P
FOR INSPECTION fecelpt 15 acknowledged In space provided.
WORKMERS COMPENSA
_Tq�FIANCE AND RCW I
LS Big URE DATE
SIGNATURE AGEfMj DATE SIGNED
1111435)
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'1 ',
I
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771-0220
RECEA&66.1
NTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MAL)h ANU AFFKUVAL UK A L;t:K 111-1- 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
INED