20030652.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OFAUSINESS/
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ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL PLUMBING / MECH
ADDITION
COMMERCIAL COMPLIANCE OR
CHANGE OF USE
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MULTIFAMILY SIGN
REPAIR
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USE PERMIT
ZONE R1413 NUMBER
JOB
ADDRESS
SUITEIAPT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP AMOV90
AW Permit Required
Street Ute Permit R&q'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION—
FT —
underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13 z
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
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POSTED
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SIGN AREA
HEIGHT
COMPLETE
ALLOWED PROPOSED
ALLOWED PROPOSED
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EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
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, FRONT UR SIDE REAR
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PARKING I
REQ`D I PWIDED 1/,,.
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CHECKED BY
OF CONSTRUCTION
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SPECIAL INSPECTION
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REQUIRED 0 YES
JAREA
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0
VALUATION
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Descrll�tion
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
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City Surcharge
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,4ePLANCHECKNO-
VESTED DATE
Plumbing
Mechanical
150—
THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THII VORKTO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUDILIC
Grading
DOUAIN (CURBS, SIDEWALKS, DRIVEWAYS, UARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: 180 DAYS
IL PERMIT UPAM I YEAR - PROVIDED WORK 15 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
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
1
h_-5, a,
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
HE
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
127-hT I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APVROV_AL
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 Offlcial or his/her Deputy: and Fees are paid, and
IN VIOLATION Ofi�.JHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKM 1,�*INS�Wo AND RCW 18.27.
OFFICIALS SIGNATURE ATE
SIGI R R
'425)
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I 2j, 103
7
771-0220
-
RE By DATE
AV ?NTION
off 1333
7
IT IS UNLAWFUL TO USE OR OCCUPY A 4UILDING OR STRUCTURE UNTIL
------
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 RECEIVED I -(� I
Z:�l I PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE)?/43 NUMBER
JOB Uk SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS C)
OWNER NAME/NAME OF 13USI S
: 7, ;77 7, e 2, r7l PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
15 MPJLIN13 ADDRESS LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Pounit ReWired
Street Use Permit Racfd
EXISTING - PROPOSED Inspection Required
CiTi, ZIP TELEPHONE Sidewalk Required
!E/APn-r#
,SLJ
REQUIRED DEDICATION- FT UndmWound
j2 F a Z) Wiringrequined 13
ass
NAME METER SIZE LINE SIZE I NO, OF FIXTURES PRV REQUIRED
rs I YES 13 NO 13
ADDRESS REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAG
CITY ZIP TELEPHONE
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NAME
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ENGINEERING REVIEWED BY . DATE
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ADDRESS
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FIRE REVIEWED BY DATE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
I REq2L., POSTED
I Is
=
OyEs 44o - -
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
COMPiETE EXEMP ALLOWED PROPOSED ALLOWED PTOPOSED
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EX P
NEW 50 RESIDENTIAL 0 ;�T,46�ECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.),
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
r] ADDITION COMPLIANCE OR
COMMER�IAL 0 CHANGE OF USE
00, Je
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'DATE
REMODE� MULTIFAMILY E] SIGN
PARKIN LOT AREA LANNING REVIEWED BY
REQ`D, I FIR IDED
NCE
REPAIR GRARING CYDS X FT)
OTHER
ARK
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0 PIP
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DEMOLISH 1:3.,rK
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CARPORT 'tj/ Y FIRE ALARM
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CHECKED BY 6F CONSTRUCTION OCCUPANT
ITYPE GROUP
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BER D�rfl OF RITICAL
Num N
OF' LLING rAREAS
SPECIAL INSPECTION AREA OCCUPANT
STORIES UNITS N MBER
REQUIRED LOAD
[:] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REGIID
VALUIAnON 110 r i. L; rm
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Description
FEE
Description
FEE
4+o V e.
Plan Check
State Surcharge
%
HEAT SOURCE LOT SLOPE %
Building Permit '7 1_� I City Surcharge
HE
__17GLAZING
/PiAN CHECK NO- VESTED DATE
Plumbing (a z L
Mechanical
THIS PUMIT AUTHOR[MS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: 13E DOME ON PRIVATE PROPEIM ONLX AW CONMUcTION ON THE PUBLIC
Grading
R
DOMAIN (CURBS, SIDEWALKS, DRIVFWAVS. MARQUEES, FTC.) WILL REQUI E
SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIM 100 DAYS
Engr. Inspection
EE 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, AR.ISING DIRECTLY OR INDIRECTLY
7
FROM THE 18SUANCE OF THIS PERMrE ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CffyIS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # /17
7 /0 <5'L
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN 13 CORRECT! AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TNS aWication Is not a permit uptil signed by the
CALL
Tim; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OE-LHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
MdhV OffloW or hisjUr Dopuly: and Fees arp paid, and
FOR INSPECT ON reoelpt is soltnovoledgod In space provided.
)N$Uqffi�r, AND RCW 18.27.
WORKM!1!f!fE%qATI2t
OFFICIALS SIGNATURE ATE
11� DATE
BIG R ER AG I _MgNED
(425)
—771-0220 DATE
RTfBY
TION
EXT 1333 z
IT IS UNLAWFUL TO USE OR OCCUPY A-dUILDING OR STRUCTURE UNTIL
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