20030614.pdf4
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
i wx / 7 tfqg
CITY ZIP TELEPHONE
6d mxvid,� q I c2b6 --7/3- 31/4
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME [I 111, 6
ADDRESS
V
/,boll 6(ze?nw-00
A) -
CITY ZIP
TELEPHONE
SE0,41C 9 9 1
1 -1 b/. - -7
STATE LICENSE NUMBER
EXPIRATION DATE
CjE
Ge-vic,:5fox qi 69
Y/6,
PROPERTY TAX ACCOUNT PARCEL NO.
0 o /,2
ACI 0 0 0 0 0
0 NEW
*RESIDENTIAL
co PLUMBING / MECH
E] ADDITION
E] COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
[:] REMODEL
0 APARTMENT
SIGN
0 REPAIR 0 GRADING FENCE
CYDS E] ( — X — FT)
DEMOLISH 0 TANK
o OTHER
GARAGE C] RETAINING WALL 0 RENEWAL
CARPORT De%litcov
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
USE
ZONE
JOB
ADDRESS
PERMIT EXPIRES Z-1
PERMIT
NUMBER
SUITEIAPTO
?)q " 11 A �/ e k&-)
PLAT NAME/SU BDIVI SION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Rw Pernift Roquil ed
0
0
EXISTING — P WT TO UPC 605.2
s1feet use permit ROCI'd
Inspection ReqUired
0
0
A W
SE—RVICME S
RN
lrdirx'k "qU"'d
0
REQUIRED D Q171
�d ritround
0,
METER SlZq��fBNI�ftfiffi�&f
d RV REQUIRED
YES 0 NO 0
z
M
w
REMARKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
01
z
w
AM MQUMD TO HAVE A
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE
w
VARIANCE OR CU
ADB'
SHORELINE OR ADBN
EC
INSPECTION
I NSP
I BOND
EQ'
REO'D
R
I
YE
0 YES [3 NO
0 S
IPOSTED
SEPA REVIEW
SIGN ARE A
HEIGHT
COMFLETE EXEMPT
PO
ALLOWED PPIOPOSEO�
ALLOWED PROPOSED
LLO
:xp I
F
URSUA� 'FO ECE
i
C 9 . I
�336 �-
LOT COVERAGE
PX1QWffi'(
(FT.)
ALLOWED PRopos
&F
NEI
NNEMDE
REAR
rot
3= WATM S
FF
z
z
z
PARKING
LOT AREA PLANNING REVIEWED BY DATE
5
REO'D j PROVIDED
1 I
06
CHECKEDBY
TYPE
N
OCCUPANWg
CIT
kf- -
.
_k;m 0 �
GROUP
I
NUMBER NUMBER OF
CRITICAL
OF
DWELLING
AREAS I& SPECIAL INSPECTOR
OCCUPANT
STO IES
UNITS
NUMBER V\J17A REQUIRED 0 YES
JAREA
LOAD
DESCRIBE WORK TO BE DONE DLi��-
0
a #V
- REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
w-a&A-Az—/
0
M
VALUATION
tLA��
HEAT SOURCE GLAZING % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
FEE
M ___
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
SURCHARGE NJ
llt�-i—
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT* 1 YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
'I NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION."
RECEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLIChTION 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 histhor Deputy: and Foos are paid. and
IN VIOLATION qW THE LABOR CODE OF HE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S PENS URINCE AND RCW 18.27.
OF7)LSVIG ATURE ATE
SI
DATE SIGNED
(425)
tj
=AQ�jJNT
771-0220
RELEASED BY DdE
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771- 0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
5/98
qvp
I
I . I
p
11
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
-)A C-1 -�- iQ Mel r
MAILING ADDRESS
5
0
CITY ZIP TELEPHONE
6d ntaid s; qgt)�)� I c,766--7/3- 306
NAME
ADDRESS
CITY ZIP TELEPHONE
.. I I
k NAME
I
�11117
#
ADDRESS
6aewt-000c
tt A).
0
CITY, ZIP
SecA44 If- 9 33�1!
STATE LICENSE NUMBER
EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
0 NEW ESIDENTIAL
*R
PLUMBING MECH
ADDITION 0 COMMERCIAL
o COMPLIANCE 08
CHANGE OF USE
REMODEL 0 APARTMENT
0 SIGN
0 FENCE
0 REPAIR 0 GRADING CYDS X FT)
0 DEM 0 ISH 0 TANK
0 OTHER
Ei GARAGE 0 R ING WALL 0 RENEWAL
CARPORT RZN Y
ER
(UPE.OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
at." k&Lx1EN_t hk(d
&tIIL�
NUMBER
NUMBER OF
CRITICAL
OF
D WELLING
-
AREAS
I
STOA.1
NITS
NUMBER
DESCRIBE WORK TO BE DONE
Dm
hd f Rhk
sh
o,
T
a
0'5
A-4]
PERMIT EXPIRES E�4 'Af 4-
USE
PERMIT
ZONE
NUMBER
Ob L
JOB
ADDRESS
Lqll
SUITE/APT#
Avk L2
PLAT NAME/SUBDIVI SION NO.
LOT NO.
LID NO.
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appmed 0
Rw Pefm Requkod
EXISTING
— PRoposw
lmepoctWn Ft#quired
91dowalk R*qukod 0
REQUIRED DEDICATION— FT
_1=1red
mderground
0
METER SIZE
LINE SIZ:
NO. OF FIXT
PRV REQUIRED
PUI SU
TO U
NO 13
UP
&
cc
UA
REMARKS
I
OWNER/CO
ff0ME=1Q*DV&
a
z
ENGINEERING
PIEVIEWED/DATE
FIRE REVIEWED BYPURSUAN'T TO ECDC 19.30-01A
w
m
APRESSUREREGULATMVALVEM
VARIANCE OR C6M
Lb�W
TqAbWTION
BOND
TM WATM SHM)Iff
REO'D
POSTED
YES (:) NO
SEPA REVIEW
SIGN AREA
HEIGHT
EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
I
,
LOT COVERAGE
REQUIRED SETBAC
PROPOSED SETBACKS (FT.)
ALLOWED PROP09ED
FRONT SIDE
FRONT L/PISIDE REAR
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REO'D I PROVIDED
I
I
CH9CKED BY TYPE T occuPANrA,0-
GROUP
Crz . I I-'%*. /
SPECIAL INSPECTOR JAREA OCCUPANT
REQUIRED 0 LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/1FINAL INSPECTION REQ'D 5
,,VALUATION
HEAT SOURCE GLAZING % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE PLUMBING
MECHANICAL
FEE
�A
THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
ORADING/FILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
It
SEPARATE PERMISSION.
2
.5;06 SURCHAR GE
m
PERMIT APPLICATION: 180DAYS
_GZJ
06
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENO. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES Of WHATEVER NATURE, ARISING DIRECTLY 08 INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
9
- DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
RECEIPT,��—)
=1
A
TOTAL AMOUNT DUE
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
OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
THE
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION
Building 011icial or histhor Deputy: and Foos are paid, and
receipt is acknowledged in space provided.
IN VI OF THE STATE OF WASHINGTON
WORKMEN'S PENS CE AND RCW 18.27.
OfE tAL SIG ATURE ATE
��S�I��IQENT DATE S D (425)
771-0220
1, wvo
EXT 333 RELEASED BY D&E
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL '471
** -0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF��- ORIGINAL -FILE YELLOW- INSPECTO
SOR'�
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD -ASSES R
W98