20030548.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER ;ME/NAME OF BUSINESS
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51 MAILING ADDRESS
CITY
ZIP
TELEPHONE
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020771-
6022
NAME
ADDRESS
CITY
ZIP
TELEPHONE
NAME
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VANKS
E-2-12" 12ALLA5
ADDRESS
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L401" PL
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TELEPHONE
STATE LICENSE NUMBER
EXPrTION DATE
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71)'Z' 1 IPERMIT EXPIRES
US127 PERMIT
ZONE NUMBER JM3
JOB SUITE/AP`,Tj
ADDRESS =i 14 m ]2y'."
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
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REQUIRED DEDICATION— Fr
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OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
REMOVALY
FIRE REVIEWED BY
DATE I lox",
VARIANCE OR CU SHORELINEORADB# 1, INSPECTION BOND
REO'D POSTED
13YEs 13NO Is
SEPA REVIEW SIGN AREA 1 HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED I A-LLOWED . PROPOSED
NEW
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRON T LIR SIDE REAR
1�
0 ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA PLANNING REVIEWED BY DATE
1:1 REMODEL
0 MULTIFAMILY
SIGN
REOD PROVIDED
REPAIR
GRADING CYOS
o FENCE
X Fr)
REMARKS
DEMOLISH
TANK
[3 OTHER
GARAGE
o RETAINING WALL
o F RE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
U ON OCCUPANT
GROLIP 9S
NUMBER
OF
NUMBER OF
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AREAS
SPECIAL INSPECTION
OCCUPANT
STORIES
I NUMBER
REQUIRED [:] YES
JAREA
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOMAIN (CURBS, SIDEWALKS, DRWEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2
I PERMrrAPPUCATION: 180DAYS
PERMIT IUMM I YFAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAtfr, 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 #
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 q;
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.-
#
Recording Fee
Receipt
I HERE13Y 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
Building Official or hlOer Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSAT
.��ffE AND RCW 18.27.
ED
SIG71TURE (OWNE R 64" DATE SIGN 1
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771-0220
—R —As
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ATTENTION=
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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
FINAL PROJECT APPROVAL FORM
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2 PERMIT EXPIRES
us PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS =114 MAP
OWNER NAME1NAME OF BUSINESS D
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
C-RAQ�: PF__TMF_jc�_ LID FEE S
MAILING ADDRESS TESCP APPO"d
PUBLIC RIGKr OF WAY PER OFFICIAL STREET MAP AW Ps"Nt Requked
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REQUIRED DEDICATION— FT UWWW"W
[7�0— WWmqr@qWr*d
NAME METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
YES13 NO 13
ADDRESS REMARKS
0 OWI
WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP
NAME
ADDRESS
ME& L�Q_N PL
FIRE REVIEWED BY DATE
i1UPTELEPHONE
1- FDR'e5l ot
ftc
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- VARIANCE OR cu SHORELINE OR ADS# INSPECTION BOND
STATE LICENSE NUMBER EXI'VIATION DATE C Y REO'D POSTED
I 113YEs
.
k III 13NO
"PAN K5 00 1 K F %NV11C
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY�TAX COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP , I ,
. RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
0 NEW. 01 ALLOWED PROPOSED FRONT SIDE. REAR FRONT L/RSIDE REAR
COMPLIANCE OR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
[3 REMODEL 13 MULTIFAMILY 13 SIGN REOD I PROVIDED:
[3 GRADING FENCE ---
RFPIUR CYOS 0 X FT) REMARKS
DEMOLISH 1ANK E] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT SOCKERY FIRE ALARM
(TYPE,OF USE, BUSINESS.OR ACTIVITY) EXPLAIN:
ALA CHECKED BY ION OCCU
PE& I
hj4' ) N GROUP
NUMBER NUMBER OF CRITICAL -OCCUP ANT
OF DWELLING AREAS SPECIAL INSPECTION JAREA
LOAD
STORIES UNITS NUMBER REQUIRED DYES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTI N REaD
zj
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE T____'�LAZING % LOT SLOPE % Building Permit
'0001—
City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
VMS IPERMIT AUTHORMES ONIUV THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
BE DONE ON PRIVATE PROPERTY ONLX ANY COUSTRUCTION ON THE PUBLIC Grading
DOMAIN (cuRes, sioEwALKs, DFimmAys, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERM I IMON. Eng.r. Review
PEWITAPPLICATIOW 180DAY8
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PIW PERMIT FOR MORE INFORMATION
Plan Chk. Deposit
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review
#
;APPLICANT,
N 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 CLAIMS FOR DAMAGES OF WHATEVER NATURE. AFUSING DIRECTLY OR INDIRECTLY % -
Total Amt. Due
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT Srr'%� Landscapelnsp.
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMEW OF ANY CITY ORDINANCE
NOR Llyrr IN ANY WAY THE CI1Y8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt N
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN is CORRECTI 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- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building orilicial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recelpt Is acknowledged In spece providad.
WORKMENS COMPENSAVW CE AND RCW 18.27.
OFfLCAALS 15RE D TE
G,
L LDATE SIGNED 1A9
BIG TURE (OWN7R[A&ENT) 5)
'74-2 -02 771-0220 DATE
ATTENTIONL-j 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTO
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUN71NG
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