20030554.pdfUM
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRES13 f
101, otgox 1?17 —
CITY ZIP TELEPHONE
6t �2006) ffp I
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NAME
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ADDRESS
CITY LEPHONE
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NAME CBL#
��a�,e� 6;P&V& "710
ADDRESS
,66�ri5-4-P401-0<
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
CIA 5 17ZA4 C. r � �lv.11,1 1 C/9' >/, P, 0-
PROPERTY TAX ACCOUNT PARCEL NO.
0 4-' 0
NEW RESIDENTIAL PLUMBING MECH
0 ADDITION COMMERCIAL
CHANGE OF USE
REMODEL MULTIFAMILY 0 SIGN
REPAIR GRADING 0 FENCE X
CIDS FT)
DEMOLISH TANK OTHER
oGARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(ME SIN!"
mf (31VITY11 LAIN:
NUMBER NUMBER OF RITIW
OF DWELLING AREAS
STORIES UNITS NUMBER 11A
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GIAZING % LOT SLO - %
I - 1 4 2-�? -
PLAN CHECK NO.-- � — 102N I VESTED DATE
USE
ZONE
JOB
ADDRESS
PERMIT EXPIRES i�&
PERMIT
NUMBER
PLAT NAMEISUBDIVISION NO
LOT NO.
LID NO.
LID FEE 6
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TEscP AW&v4d
11WP*rrrAtR9Wk6d
Trem Use PeffrA Asq'd
EXISTING __ PROPOSED
InspecUonPosqukod
gmawalkRaqulfed
REQUIRED DEDICATION— FT
umwwmvia
IWkingrequWod 13
ME
INE SIZE
NO, OF FIXTURES
PRV REQUIRED
I-
YES 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
I L
FIRE REVIEWED BY
DATE
M.
VARIANCE OR CU
ORADB#
INSPECTION
BOND
%W
REO'D
I
i
POSTED
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I 11b.
4
OYES A
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE . EXEMPT
I ALLOWED , PROPOSED I
ALLOWED
, PROPOSED
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
I
I
. dds�'�
PARKING
LOT AREA
PLANNING REVIEWED BY DA)E
RECID
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I PROVIDED
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CHECKED BY ITYPE OF
SPECIAL INSPECTION JA
REQUIRED [] YES
REMARKS
PROGRESS INSPEC
Description
Plan Check
Building Permit
Plumbing
Mechanical
PER UBC
FA
OCCUPANT
GROUP
OCCUPANT,
LOAD 2.a
INSPECTION REO'D
FEE
Description
FEE
State Surcharge
1Aft.,&,%
City Surcharge
a.n -,,
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THIS PERMIT AUTHORGMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. LTC.) WILL REQUIRE
3
SEPARATE PERMISSION.
t:
Engr. Review
PERMITAPPUCATION: ISO DAYS
CL PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WrrHIN 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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapoinsp.
Total Amt. Due
I_ZiU�
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
im
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
A ROVAL
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 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
FOR INSPECTION
Building Official or histher Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
WOR KMEN'S COMPE CE AND RCW 18.27.
OFFI& E PATE I
-
(OWNLER AGLE",,/
DATE SIGNED
1A 13
XITU
�IGURE
nllllll�l
771-0220
-RELEASED BY I DATV
AT ENTION
Ex r 13 3 3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL - . �/ I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR GINAUI-FILI, - Y LLOW JINSPEtTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P= - R - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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No. Stories: I
Occuimanev established bv this certificate:
I Dwellina Units: **NW*
E21S1
Construction: VN Basement: N/A
(Per U.B.C. 1002)
1,', must remain posted at aft times.
�JA
fival FpUngafth
owner of Building: Edmonds Arts F91 d kffl 12gM 629.'Edmonds, WA 98020
�es
THE ""' AWAO.Oko D-AsCOMPLYING WITH THE REQUIREMENTS OF THE
Ival Foundlfign4i�As BEEN:INSPkM V#.
Edmonds Arts
jVLEDMON OF THE UNIFORM BUILDING CODE AS,4%DOP*ED BY THE'ary, FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE
FOR WHICH THE PROPOSED OCCUPANCY IS CL�iFIED.
Issued this 28th d by of_jjngM 2004
CHIEF BUILDING OFFICIAL
BY:
shll��Id In legible condition at all times. Any change of occupancy or use requires a building peffrit and a new
This certificate shall be posted In a conspicuous public &me and shall not be removed, mijillated or obscured and
Certificate of Occupancy Issued by the City of Edmonds Building Official.
Maximum Occupant Load
Room capacity signs,,
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INSPECTOR E APPROVED
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FOUNDATIONs I I
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*too 0 a 6 a 0 6 4 9 0 0 0 a a 0 $000" Wall LtititIfikit LL
IL I I t Pier/Porch ItIIIt 4ir
II1ittta4 Retaining Wall
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ItitU3
MING I I �4 itPLU
I1IIiffILI IUnderground, *%*;a All IILLL ,[ r' I I
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IIIILtIt -fill I I I j I I it q iff�oFkk �7— ILI1Commercial, Final
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1IitIL, IIIititA IIIVMERIOR SHEATHIM 1
.4� jr P' �L., ell LIItDifNAILING'f itIIitIitFKAMINU as* so a $&as* 9 906 *0 406006 0 LtVOL
Lt' IIIlee FIRST,FLOORlFRAMING.... tIf fitI ILtLt P. . I I . . I I I k' f ItI
Iage#*@, I I I I . . ififitit1It4 j Floor Insulation* V. I5F 4 1 1 44
IfWall Insulation
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t41 fCeiling Insulation,' IIitIIIIII I t. It t.1 +1 1 1ISHEETROCK NAILING
... ..... ...
IilliIfL SPECIAL INSPECTION fag 14 IVpr 1 1, 1 1 L
rd
LtMISCELLANEOUS
rl:;,.r FINAL APPROVAL FOR
I1 1 4 1 '1 L /I if 1. 11., 1 1 .1 1 1 ..... I 4 OCCUPANCY tILt jr
tIThe initials RSR Rick S f I I 4 1Roberts, a temporary contract
I1I14 inspector for the C1 ty
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C.
PERMIT EXPIRES
-DATE RE
USE
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CITY OF EDMONDS ZONE N U M B E R Z,%O 0 5 Sq
_CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
_J�! OX '� A?.-?
, to,__g I I
CITY ZIP TELEPHONE
±jL5- &.3'-
g�;7/ 901
-
NAME
gLag-2 1A
ADDRESS
__ 4ff!�� /
CITY ZIP TELEPHONE
NAME- CBL#
40�_Wj4e I
ADDRESS
,653- WW
CITY ZIP TELEPHONE
45FDAPW 4��7;9-047
GTATELICENSE NUMBER EXPIRATION DATE I PRE
C1145Floacr 4 j� �I>Lp' ;_Az7''
PROPERTY TAX ACCOUNT PARCEL NO.
2-740-le10 0"
NEW
RESIDENTIAL
PLUMBING / MECH
0 ADDITION
COMMERCIAL
CHANCE OF USE
REMODEL
0 MUI.TIFAMILY
0 SIGN
[:].REPAIR
GRADING CYDS
[3 FENCE
( X FT)
DEMOLISH
TANK
0 OTHER
oGARAGE
RETAINING WALL
1:3
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
OWE O(FJJSSI=�Ifl�
NUMBER
OF
NUMBER OF
DWELLING
CRITI
R
CAREAS
IV114—
ir
STOR :8
UNITS A,
NUMBER
DESCRIBE WORK TO BE DONE
9 W-A-9; ri WIWI
e J
JOB f
I 011rTFIAPT4,
ADDRESS
PLAT NAME/SUBDIVISION NO.
COT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE5GP APWOV@d
RW Pam* Roquired
su" use Parrvift Rom
EXISTING - PROPOSED
Impection Required
SidaWAM RequWad
REQUIRED DEDICATION- FT
ur4ftwo"
G'eqws�
METER SIZE
LINE SIZE
ES
P R v
:[YES
: :REQUIRED
I 3 N
REMARKS'
OVMEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY 9ATE
a, e Z= �-O-s
e7ses '
FIRE REVIEWED BY DATE
Us
0C
rL
VARIANCE OR CU
I
HORELINE OR ADB#
?
INSPECTION
BOND
REQ'D
E3YEs X-o
POSTED
10141H
AE- - _I
SERA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
'XP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
PARKING
LOT AREA
PLANNING REVIEWED BY DA
REO'D PROVIDED
I
I
Ito 10-t I
—
6. F
jAj_j'CC.g
CHECKED BY ITYPE OF-GOSTRUcTiON Ccwo . OCCUPA
SUI L I GROUP
FA
,SPEWLINSPECRON OCCUPANT,
�66UOED [j LOAD
YES
REMARKS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REC?D
DO= FEE Description FEE
1.1 -Is
Plan Chaq
I
State Surcharge
GLAZING % LOT L
HEAISOURCE S OP
�rna
Building pe
q City Surcharge
PLAN CHECK NO- VESTED DATE
?)A::�� .'
Plumbing
?/x "' AD141 H -bZ- I C)C-
Mechanical
26.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CUnBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILI. REQUIRE
WARATEPERMISS19N.
Engr. Review
PERMITAPPLICATION: 180D�VM
PERAFAT LIMM I YEAR - PROVIDED WORK 18 STAMD WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFAR"RON
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, A$SIGNS AND SUCCESORS
Fire Review
PlanChk.Deposk
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
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY C17Y ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT LHAVE 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 unfit 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
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space pravided.
WORKMEITS COMPENSADW CE AND RCW 18.27.
1
OFFI 8 81 URE PATg
I
SIGNATURE (OWNER OR AGE" DATE SIV33NED
IA13
i.5)
771-0240 �.
RELEASED BY D ATT J.
f
ATTENTION Off 1333 J./
IT is UNL�WFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINA�- Flo YELLOW IINSPE�rcR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK-WMR GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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