20030637.pdfL�
DATE
-7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINEGS
M A;I
_� ADDRESS
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I TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
PERMIT EXPIRES —.4
USE PERMIT
ZO t2a�i_ NUMBERCqy5 -4-
JOB Sul
ADDRESS -2- Z:�- czIt�
PLAT NAME/SUBDIVISION No.
L�D NO.
L D FEES
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP AP
RW Porn'11=6d
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EXISTING — PROPOSED
lmp�tson RaqWmd
SidewsAt Requirad
REQUIRED DEDICATION— IFT
Underwound
vvwmgreq
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
NAME CS1.11
"V�t_v_
I
ENGINEERING REVIEWED BY
DATE
ADDRESS
CITY ZIP
TELEPHONE
FIRE RUkWED BY
DATE
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STATE LICENSE NUMBER EXPIRATION DATE SqECKED BY VARIANCE OR CU SHORELINE OR ADBN INSPECTION
REO'D
113YEs Is
BOND
POSTED
Ou'sNji-- P C)% Z_C_�A
13NO
SEPA REVIEW SIGN AREA
TALLOWED
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
ET;: . EXEMPT . PROPOSED I ALLOWED
. PROPOSED
NEW
[3 RESIDENTIAL PLUMBING / MECH
0 ADDITION
*'COM MERCIAL
COMPLIANCE OR
CHANGE OF USE
[3-IREMODEL
MULTIFAMILY
SIGN
0 REFAIR
[3 GRADING
FENCE
CYDS
X FT)
DEMOLISH
TANK
OTHER
GARAGE
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RE SPRINKLER
JrF
CARPORT
ROCKERY
RE ALARM
(TYPE OF USE. BUSINESS OR ACTWM EXPLAIN:
bfl� q
<>T.D <F_
NUMBER
NUM13ER OF
CRITICAL
OF
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AREAS tj I k-
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
2�7
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED 1 1 0.
REMARKS
CHECKED BY JTYPI� �OC)TUCTION CODE OCCUPAWj
WE le, ___ Y7 GROUP m
SPECIAL INSPECTION ]AREA OCCUPANT
REQUIRED LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE '0'
dv�
VALUATION
Descilption
FEE Description FEE
Plan Check
9
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I
Building Permit
City Surcharge
PLAN CNECKNO: VESTED DATE
Plumbing
K
A
Mechanical
THIS PERMIT AUTHOHEIMS ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPEM ONILV. ANY CONSTRUCTION ON THE PUBILIC
a
Grading
m DOMAIN (CURBS, SIDEWALKS, DRIVEWAVS. MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION: 160DAYS
PERMIT UMrP I YEAR -PROVIDED WORK IS STARTED WITHIN 1180DAYS
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
J
Receipt # 404AI
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
LIT
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 AM CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
I
Recording Fee
Receipt #
I HEPE13Y ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLI0 IROVAL
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 note 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
receipt Is acknowledged In space provided.
WORKMEN'S S99 INSURANCE AND RCW 18.27.
,WqkSATION
6=111
FI ATU D TE
SIGNATU JER.� �2!V NGD
('409.5)
7 220
71-0
(1
ED BY DITE
ATTENTION Off 1333 oJA
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL MAnda-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIG'INAL-FILE - YELLOWASPEcAR
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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FINMZ�ROJE C'T APPROVAL FO&.4
TO:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
DATE:
MICROFILM
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Si
Date
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ECEIJO [PERMITEXPIRES
USE PERMIT
zo NUMBER
CITY OF EDMONDS ii%�_� &..-
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER RAMEINAME OF BUSINEr
9145"
W'Gr
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
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LID FEE $
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TESCP Appivied
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permh Rwpftd
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CITY
tj
EXISTING - PROPOSED
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Inspealm FlaqLdred
SWars* Req.*-od
ITELEPHONE
4
REQUIRED DEDICATION- FT
Undwgrv"
y'1nngF4qWM
NAME
METER S17-E LINE SIZE NO. OF
FIXTURES PRV REQUIRED
YES [3 NO E3
E
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
NAME CBLjj
ra.
0 'j
ENGINEERING REVIEWED BY
DATE
9C
RE 8
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FIRE REVIEWED BY
DATE
LU
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CITY Zip TELEPHONE
lot-
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STATE LICENSE NUMBER EXPIRATION DATE CLJECKED BY
VARIANCE OR CU SHORELINE OR ADS#
INSPECTION 1. BOND
REO'D POSTED
1E3YEs
M
OL C., 1E J� 1? 0 C_ '�131jo Af
ONO
k
17-
SEPA REVIEW SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
AlEXP
,
,
M
C
rn
LOT COVERAGE REQUIRED SETBACKS 14OPOSED SETBACKS (Fr.)
NEW RESIDENTIAL 0 PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE R FRONT LIRSIDE, REAR
COMPLIANCE OR
ADDITION MMERCIAL CHANGE OF USE
By
PARKING LOT AREA PLAN741REVIi DATE
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REMARKS
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CARPORT ROCKERY 1
0
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHEQKED BY ITYtE&CURUCTION
TCODE OCCUPANM
GROUP
M M
NUMBER HUMBER OF CRITICAL
OF DWELLING JU( AREAS
SPECIAL,INSPECTION
UWUrANI
LOAD
STORIES U NUMBER
JAREA
REQUIRED
DESCI
91BE WORK TO BE DONE
C
REMARKS
PROGRESS INSPECTIONS PER UBC
11081FINAL INSPECTION REGI'D
M C).
VALUAnON
$ q
_W6=
DescrIption FEE
DescripUan FEE
z
Plan Check
State Surcharge
0 1
HEAT SOURCE NG % LOT S.LOPE % Building Permit
City Surcharge
171
PUN CHWK-NO: VESTED DATE
Plumbing
Mechanical
THIS PEMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading
DOMJUH (CURBS, SIDEWALKS, DRIVEWAYS, MMUEES, ETC.) WILL REQUIRE
t-"
SIEPARATE PMUISSION.
Engr. Review
PERMITA PPUCATIQft 00 DAYS
PERMIT UMM I YEAR -PROVIDED WORKis STARTED WITHIN 186DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFOWA'nON
Plan Chk. Deposit
A J914-1
;APIM ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
RE , AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
N NTM
Fire Review
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 11118 PERMIT SHALL NOTBE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAYTHE CnY8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAC'
GIVEN 15 CORRECr AND THAT I AM THE OWNEFI, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This aWleation Is not a pern* Until signed by the
TION. AND IN DOING THE WORK AUTHORM THEREBY NO PERSON WILL BE EMPLOYED
Buliding 0111dal or hisftw D": and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is 9A*nowfodged In spaoe proMed.
WORKMEN'S 59464SATION INSURANCE AND RCW 18.27.
4, - -
E
(0 ER GE
DATq SIGNfO
(425)
WATU
771-0220 _A
manism
ED BY E
.
ATItNTION
Off 1333
A A
IT IS UNLAWFUL TO.USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
1 it
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING