20030649.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
141
j t) 1.� r" F= 1) h a Q_
MAILING ADDRESS
(A I ( 6A_rrfa_ L1:qfUrt_1
CITY ZIP I TELEPHONE
9h.(vt0('Jb3 2V611qz6_-271-J2*'
NAME
ADDRESS
CITY
NAME
Alle 4
ADDRESS
0 06k a&,5-
CITY
ZIP I TELEPHONE
ZIP I TELEPHONE
STATE LICENSE NUMBER EXF
# eca zc4 e) e
PROPERTY TAX ACCOUNT PARCEL NO.
2,�?_-7 6
Re)L, a 2-6-0
XPEW
RESIDENTIAL
COMMERCIAL
,KADDITION
REMODEL
MULTIFAMILY
REPAIR
E] GRADING CYDS
DEMOLISH
1:1 TANK
oGARAGE
[3 RETAINING WALL
CARPORT
__ROCKERY
I(TYPE OF USE. BUSINESS OR ACTlVrM EXPLAIN:
&"/-
Z>ireK
NUMBER
NUMBER OF
OF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE
CBL
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBERA&I
J013 SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Req'd
EXISTING - PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
Wking required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
I
I
YES 13 NO C3 z
REMARKS I
OWNERICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
- - V, '.vva�tltl I'v '. ni
=Off-,, M F.)
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
0 SIGN
FENCE
I - X-FI)
xOTHEP/j�W
0 �JRE SPRINKLER
FIRE ALARM
REVIEWED BY
L-4 -R:2% I L
FIRE REVIEWED BY
50AW
W
VARIANCE OR CU
SHORELINE OR ADB11
INSPECTION
BOND
I
REO'D
I
POSTED
I
I
------
13YES9;KO
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
_XP ,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
�5NT I R
Ll)�o
PARKING
LOT
PUMNING BY DAT
REO'D I PROVIDED
AREAJ
REVIEWED
C6
I CHECKED BY ITYU�l
CRITICA 0'roo" �C�00' I
AREAS SPECIAL INSPECTIOZ7' rAREA
NUMBE REQUIRED
[] YES
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D
VALUAnON
Description FEE Description FEE
Plan Check State Surcharge .41
HEAT SOURCE GLAZING % OT SLOPE % Building Permit _T City Surcharg
PLAN CHEC:a
VESTED DATE
Plumbing
/-ai � e
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: IGO DAYS
LIMM I 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
PlanChk.Deposft
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
I
Landscapeinsp.
Total Amt. Due
,4D NOR LIMIT IN ANY WAY THE CITY'S ABILFTY TO ENFORCE ANY ORDINANCE PROVISION.-
x
Recording Fee
Receipt #
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
C
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 histheir Deputy: and Fees are paid, and
To
IN VIOLATION OF THE LABgA=Qf OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space prAvided.
JE�
WORKMEN'S COMPENSATKVUNSURAIWf AND RCW 18.27.
cl IGNATU DA
Ih
S1 URE(OWNER
DAY SIGNED
(425)
74
( _/001 3- 0 _.
771-0220
1- -
ii�
REL BY / DATf
ATTENWN
EXT 1333
AJA A.
IT IS UNLAWFUL T04JS/E OR OCCUPY A BUILDING OR STRUCTURE UNTIL
W-ffz IWZ/ K49 )_L1_1r_7yA_A
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
8R,IG-INAL -FILE YELLOW- INIPECTOP(
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
z
0-1
M
am
OC
m
m
Z
"n
O�
8
6 Fn
C
0
W
z
0
11
0
m
r
4WI -SAI-OM,-
APPROVFD oy PLANNING
-r
IS REMSIBLE FOR
t AND DRAINAGE
APPROVED AS NOTED
BY ENGINEERING
Date: 2
I
j;�Ji, . ,
WIN AT. lP12n_lrF.VT APPROVAL FORM
z
9
0
m
:; 9
ui :0
om
c
mo
0
80
c
-4 C
X rn
M z
10--1
c
0
n
m M
a 65
0
o
C
M 0
Z
z
z
9
0
m
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
si-
ocaprvl.doc.l:temp:bldg:formsIO/OI
I
q;ZT RECEI
PERMIT EXPIRES
PERMIT
ZONE AV
C_1T_Y OF EDMONDS NUMBER 101709�
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
gmblkf" P-6:01fizite-t<
MAILING ADDRESS
bt( LPturx-
CITY ZIP TELEPHONE
ff is I'vt 0 rij b-S 7126 1-1 q7,6-- 7 71-,-,,53__f 0
NAME
CITY
ZIP
NAME CBLj
4__ev#7*t-r-rt
ADDRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRA110PA DATE D
en
e
PROPERTY TAX ACCOUNT PARCEL NO. f
�-z 16,:3.9, *2 2.6—o^&3
EW
02 RESIDENTIAL
[:] PLUMBINGIMECH
ADDITION
I
)E(IREMODEL
7
COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
1:1 MULTIFAMILY
SIGN
0 REPAIR
0 GRADING
CYDS
rl FENCE X FTI
(
DEMOLISH
TANK
0 OTHEP/
GARAGE
RETAININGWALL
[j FIRE SPRINKLER
CARPORT
ROCKERY .
FIREALARM
M?E OF USE, BUS114ESS OR AC71VITYI EXPLAIN:
Z? V_,� 4—P D / r e 1, 1 -, ,
NUMBER NUMBER OF CRITICAL
OF, OW
UN ELLING AREAS
STORIES ITS NUMBER,
DESCRIBE WORK TO BE DONE
JOB
SUFTE/APT#
ADDRESS
az:��
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCF
Parr
AW F=
S"M We Perrnk Reced
EXISTING __ PROPOSED
trapection PAqtkw
Sidewalk paqjm
REQUIRED DEDICATION— FT
1 Undargmund CI
METEn SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
i
I YES13 NO [3
REMARKS
O`WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
Vein 1 1 or-n-N I Ae-1,047)II A k14f 4 ni
r_V dlfc I n A
ENGINEERING REVIEWED BY DAT
a=
'R -5101
I
FIRE REVIEWED BY
DATE
m
V IANCE OR CU
REQ'D
POSTED
1$
E YES
3 9*
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
PROPOS
ALLOWED ED
,
5 1
I at
EXP
,&
.
LOT COVJEFRIAA
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED OSED
ff �Wf4
jr
F 0 LUI
P e,.
BY DA
PARKING LOT AREA, I
REQ`D I PROVIDED
W0d3-v-r_a, I "7,sr_--nM
PL_WING RaIEWED 06
n- A
'N
CHECKED BY TYPE _9EXj,0VSTRUCTION OCCUPAN;T4&
GR
7m
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED[:]yES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
"of 11! 1 t
I HUI
14 la
7ALUATION
WWRINN I== I
$
Description
FEE
Description
FEE
Plan Check
State S urcharge
HEAT SOURCE GLAZING % SLOPE %
69.7
Building Permit_
City Surcharge
V
PLAN CHECK VESTED DA
Plumbing
(
Mechanical
THIB PERMrr AUTHOREMS ONLY THE WORK NOTED. THIS PERMIrr COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY OHLX ANY CONSTRUCTION ON THE PUBLIC
2
Grading
3 DOMAIN (CUrM, SMEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
E n gri.
PERMIT APPILICATIOft 1140 DAYS
PERMff UMFr I YEAR - PROVIDED WORK ISATARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERUrf FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEUM, ASSIGNS AND SUCCESORS,,..
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C"\OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIREMLY OR INDIRECTLY
Fire Inspection
Receipt 0
1�..?
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF T641S P�.RMIIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due
- —
I
NOR LIMIT IN ANY WAY THE CrJYS ABILM TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt # �112
1 HERE13Y ACKNO EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVIKII
GIVE IS CORRE AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE R 'An E TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TtilsapplicatIon is ra a pmmit ura sigrod by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PER80N WILL BE EMPLOYED
BuildIng Official or hieftw Deputy: and Fees arc paid. md
IN VIOLATI N OF THE LABOR-=E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt to acknowleftsd in "co PrAwed.
WORMER COMPENiA URaq AND RCW 18.27.
167 RE(OWNER NT) IGNED 1
".,ARE (0" 7
111
DAIR-1
1
77 -027.0 BY
RE DAT(
A N N EXT 1333
IT IS NLAWFUL TO/GSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
OR GINAL �L -INIPECTOF(
A IFIN L INSPECTION HAS BEEN MADE AND APPROVAL OR &PERTIFI- --FILE YE ON
CATE OF OCCUP#kNCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
... ... ... ..
z
0
fn
C:
m
0 C
m
C
"n
0
C rn
0
z
0
I
0
m