20030626 (2).pdfI
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER N
,6Wj.NAyE OF BUSINESS
MAILING ADDRESS 00,
CITY ELEPHONE
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ADDRESS
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CITY ZIP
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NAME
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CITY
ZIP TEW. HONE
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WKX� 32
STATE LICENSE NUMBER EXPRATIOlt DATE
PROPERTY TAX ACCOUNT PARCEL NO.
M-<EW
M-�EaIDENTIAL Ea"PLUMBING I MECH
ADDITION
COMMERCIAL COMPLIANCE OR
1:1 CHANGE OF USE
1:1 REMODEL
0 MULnFAMILY 0 SIGN
REPAIR
G CYDS' 13 FENCE x FT)
DEMOLISH
OTHER
TANK 11
9?eAGE
RPORT
RETAININGWALL FIRE SPRINKLER
ROCKERY FIRE ALARM
OWE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES __3 1 UNITS NUMBER
DESCRIBE WORK TO BE DONE
n V., Its) -
""� Y--/< ( *.5((, b-1 -
GLAZING %
PLAN CHECK N%.,') VESTED DATE
THIS PERMIT AUTHORM ONLY THE7ftRK NOTED. THI 1 PERM OVERS WORK TO
BE DONE ON PRIVATE PROPERTY0 r CON:XUCTI ONTHEPUUBILIC
IN
IV VS.
13 DOVJUN (CURSS, SIDEWALKS, I , MARQUEES C.) WILL REG IRE
ATEP I"
SEPARATEP ISSION.
PERMIT APPLICATIOl D
D
At D WITHIN ISO DAYS
01
q IC, T )FORMATION
L PERMIT L1MrP I YEAR - PROVIDED WORK
SEE BACK OF PINK PERMIT FOR M E
I %MTll
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. IRS, ASSIGNS AND SUCCESORS
I
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AINHOLD 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 MODIF% WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABIL17Y 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 VIOLATION 9"-IHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN$ rMPENSATION INSURANCE AND RCW 18.27. -
alai WNER AG DATE 610 al)
021 PERMIT EXPIRES
USE PERMIT
ZONE
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J013 E/APT#
ADDRESS (? 3z 01ij r" P, C
PLAT NAMEISUBDIVISION NO, LOT NO. LID NO.
LID FEE $
TESC APIWOVV
PUBLIC RIGHT OF WAY PER OFFICIAL TREET MAP
x street Use Permit RWd
EXISTING (94 PR ED Inspection Roquired
Sidewalk Required
OT FT ndorW
REQUIRED DEDICATION- U Iring r=ed
METER SVIE LINE SIZE NO. OF FIXTURES P EQUIRED
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YE NO 13 3
VIA 5
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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PARKIN L REVIEWED,BY DATE �,4
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SPECIAL INSP§CTION JARtA %A99"'I cta.!�'o OCCUPANT
REQUIRE% YES lust'ju, �as LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG-0 19
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
CALL
FOR INSPECTION
(425)
771-0220
A"I'TENTION hx I I
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
(N—_ —Ir-- a - —�_ J —� . 4. A.V'% I F3
FEE Description FEE
State Surcharge in
9i ' - 4119D
77'(1f04 City Surcharge'- _�; ou
Plan Chk. Deposit
Receipt #
Total Amt. Due /21 ilzq 25
2i
eipt # 1 &.122
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy; and Fees are paid, and
receipt Is acknowledged In sqace provided.
FFICIALE-W NATURE D,6TE
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04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
VAJE
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PINK -OWNER GOLD -ASSESSOR
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DATE RECEIVED
[PERMIT EXPIRES
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CITY OF EDMONDS
USE ERMIT -;I -
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NUMBER
CONSTRUCTION PERAIT APPLICATION
JO
ADIDRESS r (,-)I C
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OWNER E OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
/1A
MAILING ADDRESS
FEE S
YESCP APP(mad
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PermftpR' ukod
S"M Use Permit Req'd
CITY TELEPHONE
EXISTING 4-2 PROP Impaction ReqUir*d
ZIP
'VED Sidew" Raquirod
UndwWound
REQUIRED DEDICATION— FT WMg faquired
METER S!IJE LINE SIZE NO. OF FIXTURES PRV ffiEQUIRED
VIA Y E SIR NO 13
ADDRESS
REMAnKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ITELEPHONE
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fee) 1;2
NAME CBL#
ZAP
ENGINEERINd REVIEWED BY DAT
Aff
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CITY ELEPHONE
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STATE LICENSE NUMBER EXPIRATIO4 DATE, 01,11WKED Y.
ANCE OR 4 RELINE OR ADB# SPECTION BOND
REQ'D POSTED
L 0k;j 1-7
(MA
13YES VAO $
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW 8 AREA HEIGHT
S
CQMJLETE EXEMPT LO PROPOSED ALLOWED PROPOSED
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4ED,1
ENTIAL MBING I MECH 117
[jj1<EW 0,11ESID U-01FLU ': ;
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,o3ovPERAGE REQ RED SETBACKS (Fr.) ROPOSED SETBACKS (Fr.)
SIDE R FRONT
ROPOSED FRONT�. L/R SIDE PAR
t
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
.1 1 1
10 a 15 9�
REMODEL MULTIFAMILY SIGN
KING �F COT AREA P ING,REVIEWED BY DATF A
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FENCE
REPAIR G I CYDS X FT)
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DEMOLISH TANK
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o RETAININGWALL F RE AINKLER
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PO RT ROCKERY FIREkp"WM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CONSTRUCIJOh co OCCUPAIV-,7
GROUP T
U
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STOR'IES UNITS NUMBER
jCTiON JAF Do
SPECIAL INS ItA %Aj)qeA*' LO, CUPANT
REQUIREDJ YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER ILIBC 1108/FINAL INSPECTION REG'D
2
W &19,U -A I I
5;2f�-
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N I zr L 6,1 -X 0(fty,
TA
Description
FEE
Description
FEE
Plan Check
State Surcharge
I
LAZIN
HEAT SOURCE G T &
00
Bpilding Permit City Surcharge
1,
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PLAN CHECK NO- E 13ATE
Plumbing . 7) /1 /' -
- /_1_001
Mechanical ! I
A
THIS PERMIT AUTHORMES 01— oTEY-n PERMIT COnPS WORKTo
h BE DOME ON PFMATE PROPERITY ONL3(AW CONSTRUCTION ON THE PUBLIC
-
'7 y
Gradlng—' I __
ly
DOMAJ;j (CURBS, SIDEVIAILKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
I() . . -
V,
SEPARATE PERMISSION.
%1_1 � U
Engr. Review
PERMITAPPLICA1171OW. 186 DAYS
STARTED 180 DAYS
V
�ERMIT LIMM I YEAR - PROVIDED WORK IS )III111THIN
Engr. Inspection
AT
SEE BACK OF PINK PERMrT fOR MORE INFORM ION
'APPLICANT, ON BE14ALF OF HIS OR 14ER 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
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Amt. Due
LandscapaInsp. Total -q:25["
4 &
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
C c- I �gYee Receipt #
R :�= I'
J
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
ION APPROVAL
APPLICAT .1
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 until signed by the
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION qkTHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Foos are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
WORMIENS 5*MPMSATION INSURANCE AND RCW 18.27.
OFFICIAL Gi URE DATR_
S GNAT WNER DATE SIGNfD
1
/ q 10
'k—ul � %..,;
0 �_ z
ATTENTION
771-0220 REL DATE
X
EXT 1333
E J
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIkAL.:.FI& YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
5 COPIES
04/02 PRESS HARD -YOU ARE MAKING
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0
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