20030574.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS 7A nAAA (
15 MAILING ADDRESS
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0 2/000 76 14V
CITY ZIP
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NAME
ADDRESS
CITY ZIP ITELEPHONE
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ADDRESS
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CITY/ ZIP TELEPHONE
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STATEIUCENSE NUMBER
NEW
RESIDENTIAL
9300`PLUMBING / MRW
1:1 ADDITION
91rCOMMERCLAL
COMPLIANCE OR
13 CHANGE OF USE
0 REMODEL
MULTIFAMILY
0 SIGN
1:1 REPAIR
GRADING
CYDS
FENCE X
I FT)
DEMOLISH
13 TANK
OTHER
0 GARAGE
CARPORT
RETAININGWALL
1:1 ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OFUSE. ElUSINESS 00 ACT11VTM EXP�AIN:
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER t":3` 0
JOB SUITE/APT#
ADDRESS 7_1000 7071�t, Wer
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
7ESCP APPMOff
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Panilt Required
Street use Permit Raq'd
EXISTING - PROPOSED inap6cflon Required
Sjdew&jk Required
REQUIRED DEDICATION- FT undeMmund
Wiringrequired
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
YES C3 NO C3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
PmIn WammiMs *. (Ir—moom
I
NUMBER NUMBIER OF CRITICAL
OF DWELLJNG IV AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE I
ENGINEERING REVIEWED
FIRE REVIEWED BY DATE III
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--- I SHORELINEORADB# INSPECTION I BOND
VARIANCE OR CU REO'D POSTED
i[3YEs ONO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT I ALLOWED , PROPOSED I ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 95
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PARKING LOT AREA PLANNING REVIEWED BY DATE
RECID I PROVIDED 9L
REMARKS
CHECKED BY ITYPE OE CONSTRUCTION OCCUIA.1
1,6 6 cc ROUP
U44 CokE G
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] Ye LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REG-D
1
M
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIMEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPUCATION: 180 DAYS
PERMIT UMM 1 YEAR - PROVIDED WORK 16 STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE IHFORMATION
'APPLICAUL ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFX 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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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 C7 D STATE LAWS REGULATING CONSTRUC'
D AU=RCITY
TION; AND IN DING THE WORK IZED HEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF /TE 'STATE OF WASHINGTON RELATING TO
WORKMERS COMPENSAT!PHRSM"CE D RCW 18.27.
VW0*1�OWNER �AGENT) DATFIGNED
,_., In -1-.a3
VALUATION
$
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
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Total Amt. Due:".-,.
1�
Recording Fee IL
Receipt #
CALL
FOR INSPECTION
1A
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771-0220
APPLICATION APPROVAL
This application Is not it permit until signed by the
BuIldIng otlicial or histher Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
POFFI %IALS IGNATURE -DATE
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:
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DATE
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ATTENTION IEK1- 13 3 1 L Uj
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL RIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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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FIRE DEPARTMENT DATE,
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RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
M 0"M-1
MAILING ADDRESS
2/000 76 AY
CITY P
�F_dm� 9 0 0z, z
NAME
ADDRESS
CITY
ZIP ITELEPHONE
-3 PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUiTE/APT#
ADDRESS Z/000 70A��w
PLAT NAME/SUBD[VISION NO. LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Perrrd Required
Street Use Permit Reerd
EXISTING — PROPOSED inspecrtion Required
Sidewalit Required
REQUIRED DEDICATION— Fr Undweround
vvmg requved
METER SIZE LINE SIZE _f�D. OF FIXTURES PRV REQUIRED
I YES13 NO [3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NA�M
,V
6 7Bj#Z 2
ADDRESS
CITY ZIP TELEPHONE
zV/VWW#0C/ ?&.37
STATEI ICENSE NI IMBER EXPILVkjION DATE
41510(04,e_Z�036W c9to-5- mod,"
NEW [:] FIESIDEN11AL
ADDITION eCOMMERCLAL
REMODEL MULTIFAMILY
13 REPAIR E] GRADING CYDS
DEMOLISH 0 TANK
GARAGE RETAININGWALL
CARPORT ROCKERY
WfPE 05PSE, E�WNESS OR AcTivrm E)��NN:,
M017W fAOO
4U7V
NUMBER
OF
STORIES
NUMBER OF
DWELLING Nig
UNITS
DESCRIBE WORK TO BE DONE
&I AlAk, rA?zV44
HEAT SOURC
PLAN CHECK
BY
-7 121 1 0 3
WE I I I
VARIANCEORCLI SHORELINEORADB# INSPECTION BOND
REO'D POSTED
DYES 13NO Is
SEPA REVIEW' SIGN AREA HEIGHT
COMPLETE , EXE49T ALLOWED �PROPOSED ' ALLOWED , PROPOSED
EXP
LOT COVER GE REQUIRED SETBACKS (Fr.) PROOOSED SETBACKS (Fr)
&0PkUMBING / MEeW ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMPLIANCE OR
CHANGE OF USE I I — I —
PARKING LOT AREA PLANNING REVIEWED BY DATE
SIGN REO'D I PROVIDED
FENCE I
X FT) REMARKS 11111121
OTHER mini r-IF171%
F RE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
—NUMBER
LOT SLOPE %
I VESTED DATE
CHECKEDBY
TYPE Ot CONSTRUCTION
c IDE
0
_6V
OCCUPANT
I ft
G ROUP
SPECIAL INSPECTION
JAREA
OCCUPANT
REQUIRED
YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0
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Description FEE Description FEE
Plan Check State Surcharge
Building Perrnit_ City Surcharge
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Mechanical
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THIS PERMIT PAITHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: 13E DONE ON PRIVATE PROPERTV ONLX ANY CONSTRUCTION ON THE PUBLIC
11
Grading
3 DOMAIN (CUMIS, SIDEWALKS, URIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
t: SEPARATEPERMISBIOH.
Engr. Review
PERMITAPPILICATIM ISODAYS
PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN IGO DAYS
Engr. Inspection
8�13 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapoinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Recording Fee
Receipt #
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
APPOURoN
APPROVAI
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This applicaUon Is nort a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
BWIdIng Offictal or his/her Deptsty: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF T STATE OF WASHINGTON RELATING TO
FOR INSPECTION1
receipt Is acknowlidged In space provided.
WORKMEN`S.COMPEN!:]2t!!!!!!!�CE D RCW 10.27.
e"` L
OFFICIAL$ SIGNATURE j3ATE
SIGNATURE (OWNER ORIAGENT)
DATE PIGNED
1425)
4�0 �713 //0,.?
771-0220
gill, 11
ELMfS DATE
ATTENTION
Off 1333
MRIGINAL-FILE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES