20030567.pdf1_�
AAFAA� 4
DATE RECEIVED
7zz�Q
�_3 I PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE 4-13 5-
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS 1�
OWNER NAMEINAME OF BUSINESS
DiA,3F, F/'-% 6tEL_
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE S
z vw--16 E -%z L,6.4V:._
TESC
P:nkpploved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW . Rett.",
CITY ZIP TELEPHONE
Street Use Permit RWd
EXISTING — PROPOSED Inspectson Required
Sidewalk Required
REQUIRED DEDICATION— FT Underamund
WMg required
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13 z
I
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY 717PTELEPHONE
GAS PIPE TEST MUST BE
NAME
OBSERVED BY CITY INSPECTOR
T,* C_ C.
ENGINEERINGHF11 DATE
MIJAVITS SFUIEMT
ADDRESS
BE ACCEPIED
CITY ZIP TELEPHONE
FIRE REVIEWED BY DATE
1E
Ile
r6
STATE LICENSE NUMBER EXPIRATION DATE BY
VARIANCE OR CU SHORELINE OR ADS If INSPECTION BOND
REO'D POSTED
XCHECKED
4ALus 6y 68,8 ck-fe
13YEs 13NO $
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EX MPT ALLOWED PROPOSED ALLOWED PROPOSED
C)C:i- 57 110 0800
1 1
,
EXP
NEW RESIDENTIAL PLUMBING/MECH
ia
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED
PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
.
- z
MULTIFAMILY
REMODEL 0 SIGN
PARKING L ED BY DATE 9
OT_7R9__ P LANNING REVIEW
REOD I PROVIDED 06
REPAIR GRADING FENCE
CYDS ( — X —FT)
REMARKS
DEMOLISH TANK OTHER
GARAGE RETAJNINGWALL FIRE SPRINKLER
CARPORT ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINES OR ACTIVITY) EXPLAIN:
CHECKED By TYP N TRUCTION OCCUPANT
JC2 GROUP ;��&
P/
NUMBER
OF
STORIES
—_ I
SPECIAL INSPECT ON AREA OCCUPANT
LOAD
REQUIRED [:] is
S
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
429 F1,111 rl
t -so
LA-thT-ju
VALUATION
exrA2 ZAt"t—
$
Description FEE Description FEE
Plan Check State Surcharge
"T GLAZING % LOT SLOPE %
z
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORGMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
III: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERM SSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
06 PERMIT LIMM I 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 N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee Receipt #
I 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.
This application Is not a permit untill signed by the
CALL
TION; 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION ,"felpt Is acknowdodgod In space provided.
WORKMEN'S CE AND RCW 18.27.
INSURAN
,poMSATION
SIGNATUR (OW ER DATE SIGNED
OF L SIGNATUR DATE
1425)
771-0220
argAseb 6- ;4551...,71-01=30
ATTEN441OLN
Off 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
Z.
0
0
M
M
0 C;
M
0 In,
In
M M
0
In
C
M0
z:
0
M
a
nlrW
ji.V-KI�IIF4r, ,W -',It
4
PERMIT EXPIRES
BRIMS USE PERMIT
S E
0 N E
CITY OF EDMONDS ZONE 2a, .5 6-
NUMBER
0 B
CONSTRUCTION PERMIT APPLICATION JOB
D E
ADDRESS
0 R
OWNER MME/NAME OF BUSINESS
PLAT NAME/SUBDiVISION NO. LOT NO. LID NO.
P L A T
MAILING ADDRESS LID FEE S
TESGF APProw9d
P U a U
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Pomit R&WIfed
Iz -5 111, '1:11
Sum Use Permit FWQ1
CITY ZIP TELEPHONE EXISTING PROPOSED Inspecdo PAqtdW
Sidra"nRoWired
REQUIRED DEDICATION- FT undwwmm
q Uto _2_ 151Z4 WkMg reqtgrod 13
54-t'8
NAME METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
YES 13 NO 1:1
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY Z�IP 8AA PIPE IEST milsi BF
:]TELEPHONE
�6
�A
NAME CBL#
AFFIDAVITA SHALLL Off
L G C. ENGINEERING REVIEWED BY DATE
BE ACCEPTED
ADDRESS
S-7-4c,
z
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
5V� --M( .4
0
VARIANCE OR CU SHORELINE OR ADBO INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY POSTED
RECI'D
I
rp
13NO S
I
GAws c-q * c�&-a c:qr a. -c-) -o-1, ___113YES
SEPA REVIEW HE IGHT_
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLO PROPOSED
4:110 osc'o
EXP ,
M P,
C
m
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
PLUMBING MECH
EW FRONT LIR SIDE, REAR
RESIDENTLAL� ALLOWED PROPOSED FRONT SIDE REAR
4
�N
0
COMPLIANCE OR
�ADDITION COMMERCIAL CHANGE OF USE
C
PARKING LOT AREA PLANNING R EVIEWED BY DATE
REMODEL MULTIFAMILY SIGN RECID PROVIDED
CL
m
m
0 GRADING o FENCE X
REPAIR CYDS FT) REMARKS
10
z
[I DEMOLISH 0 j1ANK OTHER
GARAGE -1 RETAININGWALL FIRE SPRINKLER
0
V
CARPORT ROCKERY FIRE ALARM
(ME OF USE. IN�S IN'
A411 .��H_ACTIV".,EXPLA 0 , bC'UPANT
CHECKED PErN TRUCTI
GROUP
In in
NUMBER� NUMBER OF CREMCA
'OF DWELLING A AS SPECIAL INSPECTION
JAREA
LOAD
STORIES UNITS N REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 1108/FINAL INSPECTION REG 'D
M 0
Ano I I
Ezu
VALUATION
X
-4
$
!P ItOK,
Description
FEE
Description
FEE
z
Plan Check
1
State Surcharge
0 1�
m
GLAZING % LOT SLOPE %
Building Permit
City Surcharge
15—
Y22
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERIJIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
BE DONE ON PRIVATE PROPERTV O"LX ANY CONSTRUCTION ON THE PUBLIC Grading
DOLIIUN (CUMM,611)EWA W " LL REWIRE
=ZR MRI.O.UEES, ETC.) WI
Engr. Review
PERMITAPPLICATION' ISODAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review
N INTEREST. AGREES TQ INDEMNIFY, DEFEND AND HO HARMLESS I HE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS,,EMPUDYEES, AND AGENTS FROM AW AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, AFUSING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. 16SUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE crt" ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLI CATION APPROVA1,;
OWEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AU7HORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING dONSTRUC.
CALL
This appilcmdon Is not a pemit U01 to signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
INVIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIOA
k Building officiati or his/her Deputy: and Fees are paid, and
Zi"t Is acknowle4ed In spare provided.
WORKMENS CCIMPJVSATION INSURANCE AND RCW 10.27.
FF YSIGNATqRE/ DATE
SIGNATU DATE SIGNED
1425
Z/-?. 3,4 11)1_91 1 714, w
-7 -
771-0220
ATTENYION
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-OMER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING