20030592.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
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CITY ZIP
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STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
PROPERTY 16X ACCOUNT PARCEL NO.
0 NEW 13 RESIDENTIAL PLUMBING/MECH
DITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
I R M L Y
D EMODEL SIGN
GRADING FENCE
REPAIR 0 CYDS FT)
13 DEMOLISH TANK OTHER
GARAGE RETAJNINGWALIL FIRE SPRINKLER
CARPORT_________ ROCKERY FIRE ALARM
OWEPF USE, BU§INE§S OR ACTINIM EXPLAIN:
NUMBER
OF
STORIES
NUMi1ER OF
DWELLING
I UNITS
CRITICAL
AREAS
I NUMBER
DESCRIBE WORK TO BE DONE
J001fto P00P, APP12ADV— k?_0 T C-C)
AR-al,IWD P-A-Si_ OF WAIR J-d_'�OR4AL_
PERMIT EXPIRES '?-23 0-03
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USE PERMIT -Z?Z—
ZONE NUMBER ?-4�0 305
JOB UITE/APT#
ADDRESS Rile"
PLAT NAME/SUBDIVISIOZ N707.LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Parrrdt Required
Stvaet Use Permit Req'd
EXISTING PROPOSED Inspection Required 11
Sidewalk Required 13
REQUIRED DEDICATION- FT Underwowd
Whing required 11
METER SIZE LINE �� NO. OF FIXTURES PRV REQUIRED
I YES13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
FIRE REVIEWED BY
DATE
DATE
03
z
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
6?3 - i 1- -1
RECW
1 ...
POSTED
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRON T LIR SIDE REAR
-
a — —_ .
I
PARKING
LOT AREA I
PLANNING REVIEWED BY DATE
REO'D IOVIDED
!—P� I
--
22--a3
CHECKED BY
OF CO NSTRUCTION
CODE
OCCUPANT
ITYPE
I
GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED [] YES
IPROGRESS
JAREA
LOAD
REMARKS
INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
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— UATION
$ — I I
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE 5�G % LOT SLOPE %
T
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 ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: ISO DAYS
PERMIT umm 1 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
a EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt # 1--c- L_
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE CITY ORDINANCE
Landscapeinsp.
Total Amt. Due W14-1vee
OR REDUCE ANY REQUIREMENT OF ANY
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt N
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-
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 V OF T 1BOR CODE OF THE STATE OF WASHINGTON RELATING TO
'FOR INSPECTION
receipt is acknowledged In space provided.
M
MI
WKM EIT �SN ON INSURANCE AND RCW 18.27.
e-
OFFICIALS SIGNATURE DATE
SIG NE DATE SIGNED
(425)
'rENT)
8 Aj 6:�-
771 -0220 `
PRELWEASEeX
! _V
DATE
MfENTIO
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 -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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'�,.'f'DA7E RECEIVED PERMIT EXPIRES 2__3 0-423
sees
USE PERMIT
LA I T U1_ LIL)MUNILib ILUNC NUMBER 4AA-" -7 C
CONSTRUCTION PERMIT APPLICATION JOB -SUITE/APT#
ADD e
OWNER NAMEINAME OF BUSINESS RESS
LOT NO. LID N�.
MAILING XDDRESS PLAT NAME/SUBDIVISION NO. m7 LID FEE S
o r ev\,,li)
TESCP App"I"d
_�5r/' 14VE /(j PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PermA Reciahed
Street Use permit Re"
CITY ZIP TELEPHONF EXISTING — PROPOSED Ir"Pt2n Required
Sidewak Required
&4 ON CIS -7/ REQUIRED DEDICATION— FT UndwwmM
7—zo . Wiring recItArod 13
NAME METER SIZE LINE SIZE I NO. OF FIXTURES R"EQUIREO
I I I YEPs 13 NO 13
ADDRESS
CITY ZIP ITELEPHONE
NAME Cat. N
P, k C i,-k
Cc ADDRESS
1 (39 1 .6
CITY ZIP TELEPqONE
El� i-ko N Ds '77 G Z_
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
'ROPERTY TAX ACCOUNT PARCEL NO.
QO zj-2 .
qz--z �_21 t�o
NEW
RESIDENTIAL
PLUMBING / MECH
DITION
REMODEL
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
SIGN
REPAIR
GRADING
CYDS
[3 FENCE
( — X—FT)
DEMOLISH
TANK
o OTHER
GARAGE
CARPORT
RETAININGWALL
ROCKERY
E] FIRE SPRINKLER
FIRE ALARM
M?E,PF USE, BU)INE OR ACTIVITY) EXPLAJN:
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
I A004to PoOk APPR.O%,c kZ(_-3 T C-0 WCWiTL
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0 1 1,J IfLIA�C_P_ f,_kkL_('(AY2-�e AfZ-
T-(jFA
0 I`j Fl= k Tp�_; J;?- Of IST (N.4G
�A 0 NO
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICAT10W. 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. APJSING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY`6 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 WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIOL4 OF T"BOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKM 8 =N2214 INSURANCE AND RCW 18.27.
DATE SIGNED
_T8 Aic, -toO_3
SIGN�TU ENT) I-
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
VARIANCE OR CU SHORELINEORADBO I INSPECTION 1$ BOND
RE106 POSTED
(3YES
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/RS!DE REAR
W, ------------- AO
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDE Z _4
CHECKED BY TYPE OF CONSTRUCTION C Clff� OCCUPANT
I dy Y�- I GROUP
SPECIAL INSPECTIO OCCUPANT
REQUIRED [] YES LOAD
I
PER ILIBC 1108/FINAL INSPECTION REaD 9
I is
$
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 #
Landscape Insp.
Total Amt. Due
W.41 v
Recording Fee
Receipt #
CALL
This application Is -not a permit until signed by the
Building Official or tftfhar D"uty: and roes are paid, and
FOR INSPECTION
receipt Is acknowledged In space provided.
1A9
,.425)
OFFICIALS SIGNATURE DATE
6-Jr-0_3
®RE
771-0220
L E AKVS-*
.Wf DATE
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 - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN -ACCOUNTING