20030581.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
15 MAILING ADDRESS
yoy r
C �113 TELEPHONE
ADDRESS
CITY ZIP TELEPHONE
P
FERMIT EXPIRES
USE PERMIT
ZONE
re
NUMBER
JOB
SUITEIAPT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
'42,
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP
RW Pefm=od
Street Use Peffnh Reqd
EXISTING — PROPOSED
lnspftWn Required
Sidewalk Required
REQUIRED DEDICATION— Fr
Underwound
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
1
I
1
YES 13 NO C3
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REMARKS
I
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NAME CBL N
ENGINEERING REVIEWED BY DATE
ADDRESS
cJ /,A 12
_S
FIRE REVIEWED BY DATE
U1
CITY ZIP TELEPHONE
4
cc
*�EFOR —ADB#
STATE LICENSE NUMBER EXPIFIA ON DATE C KED BY
VARIANCE OR Cul SHORELI INSPECTION BOND
REO'D POSTED
[3YEs ONO $
SEPA REVIEW SIGN AREA. HEIGHT
P 0 RTY T ACCOUNT PARCEL. NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
5-600 a C-,
I ,
Exp
0 NEW �XRE SIDENTIAL 8-1p*,LUMBING f MECH
LOT COVERAGE REQUIRED SETBACKS (FT): PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRO NT LIRSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
0 CHANGE OF USE
REMODEL muLnFAmy SIGN
PARKING DATE
PROW ill
RECID 19 3'0.02
YFEAE.' 0
IPM
REPAIR GRADING FENCE
CYDS ( — X
A U M UL AMR VA I V E =0
REMARKS SHALL BE INSTALLED NEAR
011-IER
DEMOLISH 0 TANK
TfM WAIER sjjupjFF
oGAPAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROOKERY FIRE ALARM
(Typ OF BE. BUSINESS OP ACTIVITY) EXPLAIN!
CHECKED BY OCCUPANT
AW
GROUP
NUMBER N1JM&R'OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION AREA OCCUPANT
STORIES UNITS NUMBER
REQUIRED YES LOAD
I
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REaO
TO
-We 605.2
A WAT9k SERVICE SMMM
VALUATION BE INSTALLED ON THE
AS IT 01T. EM SW f E B bUbM
$
Dewription FEE DescriptIon FEE
Plan Check State Surcharge
HFAT SOURCE GLAZING % LOT SLOPE %
Buildlhg,Permft*, City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORMFS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
R
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUI E
SEPARATE PERMISSION.
Engr. Review
PERMITAPPUCATION: 100DAYS
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
—
Recording Fee Receint #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECr, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CRY 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 his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION jacelpt Is acknowledged In space provided.
WORKMEN'S COMPENSA��RANCE AND RCW 18.27.
OF S SIGNq DATE
DATE SIGNED
(425)
MRELEAS WBY
7
L
771-0220 01
Ali
AT)tNTION
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
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
e,r*MS .4 .,,
PERMIT EXPIRES A
USE PERMIT
ZONE &�$ —
NUMBER
4�
JOB SUnVAPT#
fADDRESS; dv.4a
MAILING ADDRESS
5l y3y
"C .
.... �,W Z,11P.�� ITELEPHONE
j
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7EUGF APPMVW
RW P*nrAt new*W
S"M Use Psfmil RWd
EXISTING — PROPOSED
Inspection RoqtdW
Sidevok Roqukvd
REQUIRED DEDICATION— FT
un"Www
ww-grequi-I 13
NAMY - ' -
ADDRESS R
CITY ZIP
TELEPHONE
NAME
CBL#
77e-J /0'/�A 11
ADDRESS
121
F
CITY ZIP
�T-v 1 4 - I / y 7
ITELEPHONE
3 z a--57
STATE LICENSE NUMBER EXPI ON DATE
KED BY
40 Cz 77,
PR,0,PERTY ACCOUNT PARCEL NO C
, �_ L. ]j _' "e- 0, 6 a V / �
0 0
E:
OWN
NEW XRESIDENTIAL <PUMBING'j'klIiCH A
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
0 REMODEL mummmy SIGN I
FENCE
0 REPAIR 0 GRADING CYDS X FT) F
DEMOLISH TANK o OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYP OF NESS Op ACTIVITY) EXPLAIN:
BUSI
�SE, ,
� g t
NUM13ER
OF
DNU1M6ER'OF
WELLING
CRITICAL
AREAS
STORIES
NITS
NUMBER
DESCRIBE WORK TO BE DONE f
R
A& &A 9
HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTIRUCTION ON THE PUBLIC
DONIAIN (CURSS. SIDEWAILKS, ORMVAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISS.10N.
PERM AppucATim iso DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
IIAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS,,ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY; DEFEND ANO.HOLD HARMLESS T14E Cn"YOF
'EDMONDS,
WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, AF49ING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY ThE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GWEN 18 CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
I TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
THE OWNER. AGREE
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
WORKIMENS COMPENSA�� A14AE AND�RCW 18.27.
AGEFM
DATE SIGNED
0
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED 0
YES E3 NO 13 z
EMARKS I
IWN�R*/�2ACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
6J111V,dW,ff,d11M
RE REVIEWED BY DATE
W
lz
/ARIANCE OR CU
SHORELINE OR ADB*
INSPECTION
BOND
REQ'D
POSTED
13YEs 13NO
IS
SEPA REVIEW
SIGN AREA
HEIGHT
OMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED�
P ,
I
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
-LOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
BY. DATE
PARKING
EGID PROVIDED
LOT AREA
I
PLANNING REVIEWED
. . a.
I
BCDC i 9.39.fte
EMARKS
L 44L� tNSTAIJM
HECKED BY
TYPE
CO0Eq__
OCCUPANT:'
GROUP' �112 .
PECIALINSPECTION
OCCUPANT
JAREA
EQUIRED
LOAD .
EMARKS
ROGRESS INSPECTIONS PER UBC 109/FINAL INSPECTION REaD:
PU'ftSUANT TO UPC WIX
A I I ft" W12k,
Iwo 11M —fe
Alm - r VM6�
IALUATION
T
Description FEE Description FEE
)Ian Check State Surcharge
Wilding Permit City Surcharge Aq
)Iumbing
Aechanical
Brading
=r�r. Review
=ngr. Inspection
Fire Review
Plan Chk. Deposit
Firefrispection
Receipt #
LandscapeInsp.
Total Amt. Due
me
Recording Fee
Receipt #
AV 4/
CALL
FOR INSPECTION
IA-35)%_Wx_
771-0220
APPLICATION APPROVAL - I
This application Is not a permit until signed by the
Building Official or hlOer Deputy: and Fees are paW, and
/rcelpt Is acknowleftod In space proMed.
OF s SIG U DATE
RELEAS96 BY DXTV
10011
AMNTION "I 1 6 1
IT JS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I ii
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN& -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOUD-ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES