20030544A.pdfDATE RECEIVED -7)"
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
Sol 7
OWNER NAME1NAME OF BUSI as
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
"LING ADDRESS
LID FEE S
tAW S4
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IN Pennit Required
R1tr@&I Permit 1160
CITY ZIP TELEPHONE
Use
EXISTING - PROPOSED Inspection Raquirod
Sidewslir Required
!Aorelivit— zo(t-5
REQUIRED DEDICATION- IFT Underground 13
NAME
MET RES PRV RE
ER SIZE LINE SIZE NO. OF FIXTU QUIRED
YES13 NO 13
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP NE
FIRE MAtISHAE
jCBLN
lvidff BE PRESENT FEA
i"ANIK Wk, REMOVAL, 0 "AAP
Wr
ENGINEERING REVIEWED
R
?0 -�O)c 7 -1 E12—
CITY ZIP TELEPHONE
FIRE REVIEWED BY DATE
STATE LICENSE NUMBER EXPIPATION DATE CH
VARIANCE OR Cu SHORELINE OR ADB#
REQ'D POSTED
1 1 1
'6u*4 r cli 110 0
03
k
0YEs 13NO $
BEIRA REVIEW SIGN AREA HEIGHT
Q PR3mm
COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED PROPOSED
EXP
NEW RESIDENTIAL PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (FT)' PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL muLnFAmiLy SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ`D I PROVIDED
E
REPAIR [3 GRADING CYDS F NCE X FT)
REMARKS
OTHER
DEMOLISH TANK
NG FIRE SPRINKLER
0 GAPIME RETAINI WALL
CARPORT ROCKERY JFIRE ALARM
MVE OF USE, BUSINESS OR AC"M OMAN:
ZAV
CHF CKED BY F C�OMCTHON OCCUPANKT
U �r
P GROUP
NUMBER OF
DWEWN13 A ETA S
OF Cf
NUMBER ICAL or C
SPECIAL INSP OCCUPANT
ECTION
LOAD
STORIES UNITS NUMBER
],kREA
REQUIRED YES
DESCRIOE WORK TO BE DONEp
e
REMARKS
0\1 O-sc%
PROGRESS INSPECnONS PER UBC 106/FINAL INSPEcinoN RECtO
SOD UST
.300 16!z iu�x %, 15c, M -e—
VALUAnON
whgihij! Conneckon S .
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE % LOT SLOPE %
Building Permit LS 0. City Surcharge
PLAN CHECK NO: VESTED 13ATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
t:
Engr. Review
PERMI'll'APPLICATION: 1180DAVS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
st
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS,
Fire Review Plan Chk. Depos
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 CLAJMS 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
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDI NANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt#_
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
jtjE OWNER. I AGREE M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL This arplication I a not a permit until algived by the
ON; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABUS.CPDE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is arknovirledged In space provided.
WORKMWf COMPENSAT)OftSgrCE AND RCW 18.27.
It
O!FFICIALq SIGOTUR�Ek DATE
SIGNA 6R (OWNER 0 DATE SIGNED
IA95) lj�V
77
7
771-0220
RELEASED BY DATE
ATTENTION
EXT 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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10.rAATE R�!CEIVED
F
PERMIT
EXPIRES
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER C�,02LI�&
_CONSTRUCTION PERMIT APPLICATION'
1
JOB
ADDRESS
�,fj4g
SUITE/APT#
OWNER
:� r
NAME/NAME OF DUBIN 88
1, �, W
PLAT NAME/SUBDIVISION NO.
TLOT NO.
I LID NO.
.LLAYN e * It
MAILING ADDRESS
viLiD tAw igat, s4
�%CITY TL4.EPHONE
rtj't it_ , Zip, , I -z oce - 5 6 11?
NAME
ADDRESS
CITY
ZIP ITELEPHONE
6��A cl, � 7AV,, 1�,
ADDRESS �,J
?0 & 77S'S2-
CITY ZIP
S4e gd+1 e- 921
STATE LICENSE NUMBER
r ck'13 c—L—
CBL N
TELEPHONE
206 _304-q0&/
EXPYIATION DATE CHWROW
a 44/0 C I au )
10 60,
NEW
RESIDENTIAL
[3 PLUMBING/MECH
ADDITION
COMMERCIAL
COMPLIANCEOR
CHANCE OF USE
0 REMODEL
[3 MULTIFAMILY
SIGN
0 REPAIR
GRADING CYDS
FENCE
X-FT)
.[:],DEMOUS . H
TANK
OTHER
0 GARAGE
CARPORT
[:I RETAININGWALL
FIRE SPRINKLER
ROCKCRY ,
PIRE ALARM
(TYPE OF USE. BUSINESS
OR ACTIV" LAIN:
4!sm
.11ST
44�
0 (I .,I
OF
NUMBER14,6,,,4
NUMBER OF
D WELLING
C CAL
EAS
EA
AV
2M
STORIE%
NITS
NUMBER
DESCRIBE WORK TO BE DONE�
4-)Inrf- t, I I '�,L. hAO tovinot-rian
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THEWORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWXYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PgiSSION.
PERMFT APPLICATION: 111K) DAYS
PERMIT LIMM I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE GACK OF PINK PIERMff FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESCIRS
IN iNTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, ANDAGENTS FROM ANY AND
ALL CLAJMS 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 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 THEREfff, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAqQA-Q�DE OF THE STATE OF WASHINGTON RELATING TO
WORKMEKS COMPENSAT10"SURANCE AND RCW 18.27.
LID FEE S
TESCP=gd
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW P. ired
Street use PaIrritt Re4d
EXISTING — PROPOSED IrapeLtIon FWqt*ed
SidawalkReWirad
REQUIRED DEDICATION— FT Undergrotwx!
Wft requirecl 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FOR
RUST BE PR
ENGINEERING ._jMt1VIVVML., efl
z
0
FIRE REVIEWED BY DATE us r —1
cc
M
VARIANCE OR CU SHORELINEORADB# INSPECTION BOND
REO'D POSTED
OyEs ONO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED FRONT SIDE REAR FRONT 'LIR SIDE 0
C:
PARKING 'COT AREA M
PLA,NNING, REVIEWED BY DATE
REQrD I PROVIDED
REMARKS
0
q."
IF CID ION C OCCUPANT
CHECKED BY
M M
GROU
P
SPECIAL INSPECTION JkREA OCCUPANT
LOAD rn,
REQUIRED [] YES
REMARKS 0
PROGRESS INSPECTIONS PER UNC I GO/FINAL INSPECTION REUD
3
VALUATION
Deacription FEE Des;rIptl an FEE
Plan Check State Surcharge
0
rn
Building Permit
SIG:NAr�g (OWNER GIM4,/6
DATE SIGNED
-1 - 7,3 - 6) < I
Plumbing
Mechanical
Grading
Engr. Review
Engir. Inspection
Fire Review
Fire Inspection
Landscapoinsp.
Recording Fee
City Surcharge
Plan Chk. Depo
Receipt #
Total Amt. Due
Receipt #
CALL
iR INSPECTION
TWs. application Is not a penWt until signed by the
Building Official or hi0wr Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
1A
1,125%
771-0220
OFFICIAL9 SIGVATURE ATE
I
L
--RELEASED BY DAT6
ATTENTION EXT 1 3
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
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN ACCOUNTING