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USE PERMIT
CITY OF EDMONDS
ZONE NUMBER �� 60
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS W, i'dwodd.1; A&
OWNER NAME[NAME OF 13USINESS
/
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO. -
LID FEE S
MAILING ADDRESS
7ESCP Approved
'0
1-72&V
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PermIt Required
Street Use Peffnh AKd
CITY TELEPHONE
ZIP
74-1
'A 9e/L )OL" 30
n R uIred
Inspectio aq
EXISTING PROPOSED-Sidew. Required
Underground
REQUIRED DEDICATION- FT kingrequired
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I
Y ES NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
clar-3 QMOL-
CITY ZIP TELEPHONE
NAME -TC&I:#-
a CU.
ADDRESS
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY
CITY ZIP TELEPHONE
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STATE YCENSE NUMBER E?��'DATE C"ECKEDBY
VARIANCE OR cu SHORELINE OR ADS# INSPECTION BOND
REQ'D POSTED
113YES
TE(NO S
SEPA REVIEW SIGN AREA HEIGH1 D
PLETE EXEMPT PROPO%
COM ALLOWE__DPROPOSED ALLOWED
PROP
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I
-L
EXP x
NEW RESIDENTIAL [3 PLUMBING/MECH
9
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE *44%
1
COMPLIANCE OR
1:1
1
Bgp,/o 45DA-7.S-
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ADDITION COMMERCIAL CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY
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REMODEL MULTIFAMILY 13 SIGN
REOD I PROVIDED % �0 11�-. I I—,
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0 REPAIR
Lj� Zft CYDS
o FENCE
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0 DEMOLISH
TANK
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o RETAINING WALL
FIRE SPRINKLER
0
CARPORT
ROCKERY
FIRE ALARM
VWE OF USE. BUSINESS OR ACTIV" EXPLAIN:
2—
CHECKED BY
PE
NUMBER
Ul
SPECIAL INSPECTION
OF
STORIES
REQUIRED 171 YES
DESCRIBE WORK TO BE DONE
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LOAD
PER UBC 11011111MINAL INSPECTION REO'D
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VALUATION
$ -70
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HEAT SOUJICE GLAZING % LOT SLOPE %
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Description
Plan Check
Building Permit_
FEE
EDescriptlon
State Surcharge
t
City Surcharge
Ci Surc
FEE
Plumbing
PLAN CHECK NO: 2
TED DATE
V. Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: 160DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 16 STARTED WITHIN 150 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
z Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: nIAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM. THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Offlclal or histher Deputy: and Fees are paid. and
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 FOR INSPECTION receipt lsacknoyAodged In spacyrovide
WORKMEN3_WWENSATION INSURANCE AND RCW 18.27. OFFWJUS-SIGNATURE DA E
SIGNATY% NE R AGENIR DATE SlqrNED (1425) I-Aup
aAf14 771-0220 R L BY DAT
ATTENTION M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Imme ---
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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DATE RECEIVE!�.,_J,
. CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
1?4�1? -
MJULING ADDRESS
c,19. - -796 V
CITY I ZIP TELEPHONE
<a'qld� WA (3gon )J) i, - Vz � 0 ,
NAME
ADDRESS
CITY ZIP ITELEPHONE
USE ERMIT
ZONE ER
NUMBI
on SUITE/APT#
ADDRESS 01.45
PLAT NAME/SUBDIVISION NO. LOT NO. L D NO.
LID FEE S
I ESCP APPMW
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pofmit Required
Street Use Permit Rec(d
EXISTING — PROPOSED
Ired
REQUIRED DEDICATION— FT
—1 1mg req W*d 13
METER SIZE LINE SIZE NO. OF FIXTURES/ PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
06,00.1 me ritolljoAr'-ni t4_Ar_ldt%) %�kxwAL., .1
R
NAME
CBL #
ENGINEERING REVIEWED BY 0 TE
-0h[191 03
ADDRESS a?
FIRE REVIEWED BY
CITY TELEPHONE
VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
STATE LICI�� NUMBER,_ POSTED
N.W CH REO'D
0 $
SEPA REVIEW SIGN AREA 10YES t&1T HEIGHT
EXEMPT ALLOWED PROPOSED
PAr COMPLETE ALLOWED PROPOSAD
UVO. I_ - 117* '; �jowj . ", ". "' I I - - -,. I I I
EXP Y
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.]
NEW RESIDENTIAL PLUMBINfi/ MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE
I - . . . I ;a 4!2 TMtn, 51
COMPLIANCE OR �Q '64;pp
ADDITION COMMERCIAL �- : - ��Z;6
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY
REMODEL MUVn,FA'M1:Lf SIGN REOD I PROVIDED % 2.-1
Y.
Cql 40PI
FENCE
0 REPAIR CYDS ( _ X_FT) R&Agl?'§�
0 OTHER %Vr'ftTn'aAqx:)
DEMOL[SH TANK N orr 4-AV-AC3CjF Qk-picce W—
RETAININGWALL FIRE SPRINKLER �14 r:::% I or
CARPO ROCKERY FIRE ALARM Qfkis�al.�+ '105
WE OF U&, 13USINESS OR ACTIVITY) EXPLAIN: CHECKED BY ITYPE OF CONSTR CTION OCC PA
UP
U
Nalunca NUMBER OF CRITICAL
im
Ir
'a .
OF DWELLING AREAS NJ SPECIAL INSPECTION JARE OCCU NT
17DAD
STORIES NUMBER a REQUIRED [] YES
..DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER_UBC 108/FINAL INSPECTION REaD
vEt
41-ug -To ?
�'" r2c " _k j / z.,, --r, IN
i A_ n tkl e,-n A16 a
a—,/
W/v< oggillkl-i--z
HEAT C GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
-3
E'd 1, —
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS DRIVEWAYS, UARQUEES, ETC.) WILL REQUIRE
89;ARiWPFRIAISSION.
PFRMIT APPLICATION: 180 DAYS
PER16UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUS4 HEIRS*,'ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONOS, 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 MODIFY; WAIVE OR REDUCE ANY REQUIPEMENT 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
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 OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN!
,qA)O ENSATIOIN INSURANCE AND RCW 18.27.
SIGNAME OR AGEZ DATE7NED
—7
VALUATION
$ Opp 4N
VVIVIN I
Description
FEE
Description
FEE
Plan Check
State surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
/00—
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
e Ing Fee
R card
Receipt #
CALL
FOR INSPECTION
1A9
v_25)
771-0,220
EXT 1333
APPLICATION APPROVAL
This appitcation is not a permit untH signed by the
Building omew or his/her Deputy: and roes are paid, and
welpt is acknowledged In 5pecapovidad.
OFF[ SIGNATURE 0 Al Eo�
Ito- I
(
R L By DATE
Ve-71,4 1"T2_
10110
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I I )19 1 1
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
0/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
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