20030666.pdfA
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING A
CITY -
NAME
ADDRESS
ZIP
CITY ZIP ITELEPHONE
NAME
CBL N
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
J013 SUIT 't
ADDRESS
I <fv—
PLAT NAME/SUBDIVISION NO.
LOT NO.
L�D NO.
L 0 FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Ap="d
RW POM'A
strom Use Pon
EXISTING — PROPOSED
=.Wd
SIdewatkRequired
REQUIRED DEDICATION FT
1 Undetwound
13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES13 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
00 if 0V__Wl J9P9--JF_Vk0i1S
4ZX 1=4441-4--1 LLM-f
ENGINEERING REVIEWED BY DATE
ADDRESS
M
esses . iial 8�cala_.LL_
a
/W
FIRE REVIEWEDBY DATE
CITY ZIP
TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
VARIANCE OR CiLl I
SHORELINE OR ADB#
INSPECTION
RE D
S 0
[3YEE 0
3:�2<
BOND
POSTED
$
$EPA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED SED
e2 11= PROPO
P ERTY TAX ACCOUNT, PARCEL NO.
0 NEW );J�RESIDENTIAL PLUMBING MECH
COMPLIANCE OR
1:1 ADDITION [j COMMERCIAL 1:1 CHANGE OF USE
1:1 REMODEL [] muLnFAmiLy [:1 SIGN
1:1 REPAIR GRADING [3 FENCE
CYDS X FT)
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (VT.)
FRONT SIDE REAR
I /
- 'e7tol�
I
PARKIN LOT AREA
REOD I ROVIDED
P
--2— ;:�
PLANNING REVIE1
W2�
REMARKS
DEMOLISH TANK
GARAGE RETAJNINGWALL cl FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EVIAN,.
CHECKED BY
OCCUPANT
JTYPE�r/gCTION
JC27,
GROU P
e
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER4-* _�2
.2,
-3
SPECIAL. INSPECTION 7AR
REQUIRED [:] YES
EA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IDS/FINAL INSPECTION REG'D
616'ePA'lb 6704e/V ----
VALUATION
s
Description
FEE
Description
FEE
Plan Check
/V �5
Str^9 Surcharge
HEAT SOURCE GLAZING % LOT SLOPE
T
Building Permit
5_�_
City Surcharge
.
PLAN CHECKNOI; VESTED DATE
Plumbing
THIS PERMIT AUTHOR&MS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
a
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATE PERMISSION.
PERUITAPPLICATION: 180DAYS
ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Mechanical
Grading
Engr. Review
Engr. Inspection
'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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE ISSUANCE OF THIS PERMIll. 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 C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt #
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
�S42&-7q
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AU EBY, NO PERSON WILL BE EMPLOYED
ER
ED 17 RE
ZE
Of Z
IN VIOLATION-GF-4LHE LABOP,,SURANOF H OF WASHINGTON RELATING TO
D MATE
CE "
WORKX)MIS C"SATqWlN CE 18.27.
G �
81 TUR AGE DATE SIGNED
This application Is not a permit unlit signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknowledged In space pro-Aded.
OFFIC ATURE DATE
1,425)
_�7
2n - '0 -3
r _1011NN �� a
ATTENTION 'Nf
7
IT IS UNLAWFUL TO USE OR OCCI IG OR STRUCTURE UNTIL
1 77%1-0220
EXT 1333
2-
DATE
�4`&Ax&
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE YELLOW - IN CTOV
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
Z'
0
M
=i:fi
ra �
0M
C
M
H
W r-
E� r.
M
IS
Z
0.n.
M M
0-
0
0
C
z
0
0
M
p
Ac
lu'uN - 7 20033
�,'l � I!
N-ITCOUNTER
VCH' P, 4.04
Ito I J& I..L v- �-
APPROVED AS NOTED
BY ENGINEERING
Date:
off
z
0
I
0
m
=i:fl
55 -4
om
a
ma
0
-10
oc
�m
m m
10 F,
z
0 -n
n �
� ic
m m
0 V5
0
0 Fn
C 0)
c Cl)
M 0
Z
z
z
9
0
m
RE.INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date si
ocaprvl.doc.l:u=p-.bldg:fimwlO/OI
Ne
I
q7ATE RE(t
IVED oi RMIT EXPIRES
E
USE PERMIT
CITY OF EDMONDS ZONE NUMBER,1�
STRUCTION PERMIT APPLICATION J013
—CON ADDRESS
OWNER NAIqE/NAME OF BUSINESS Ll��
PLAT NAME/SUBDIVISION NO. LOT NO. UD NO.
L;dll��=
MAILING ADDRESS
LID FEE S
YES
1453
W/
5-7— PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW
j
_)61,7— - Stme,
CITY
ZIP
'TE EXISTING — PROPOSED WAII-AGO FAQWfed
LEPHONE Sidwalk ReWired
8�b
UndwWWW
REQUIRED DEDICATION mn:::f FT Wking requirod 13
NAME
METER SIZE LINE SIZE 7. OF FIXTURES PRV REQUIRED
I
1___*1
YES 13 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE rOR EROSION CONTROL/DRAINAGE
90$ M(A) 19fr,591110itS SWzfVflC,:F,
CITY
ZIP
TELEPHONE
-r C71
TM IN&L 10SW_ 100
NAME
CBL#
ENGINEERING REVIEWED BY UATE
ADDRESS
-1 MICOULY'LL,
FIRE REVIEWED BY DATE
+E
CITY
ZIP
TELEPHONE IEL
I
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
VARIANCE OR CU SHORELINEORADB# I INSPECTION BOND
REQ�D _ POSTED
CIYES_JMQ $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP 5Z:5 1 1 .
NEW
tk"RESIDENTIAL
PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS Mr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIROIIIE REAR
COMPLIANCE OR
�70
5 V& #/I
ADDITION
0 COMMERCIAL
CHANGE OF USE
-5
REMODEL
muLnFAMILY
SIGN
PARKING LOT AREA PLANNING REVI ED BY�" IATE IL
REOD PROVIDEJD
REPAIR
"GRADING
0 CYDS
FENC
( X FT)
REMA...
DEMOLISH
TANK
OTHE
[3 GARAGE
CARPORT
o RETAINING WALL
ROOKERY
cl FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE MDQN$TWCT`ION
I J�_"
Cons �OCCUPANL,
q7 GIOUPle -3
NUMBER
OF
NUMBER OF
DWELLING
[UNITS
CRITICAL ml
AREAS
SPECIAL INSPECTION JAREA
OCCUPANT
LOAD
STORIES
NUMBERAO
REQUIRED 0 YES
DESCRIBE WORK TO BE
DONE
.
REMARKS
PROGRESS INSPECTIONS PER UBC
11081FINAL INSPECTION REaD
j
.15,z=1�6"9AM bz=,k±4_
1 HEAT SOURCE GLAZING % LOT SLOPE
PLAN CNECKAO' VESTED DATE
C2 a — _-IS ac -
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERUTY COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
1
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, OWGUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION-
PERurrAPPucA-nON: ISO DAYS
PERMIT UUM I YEAR - PROVIDED WORK 13 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFWAALS. 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 REQUIREMENT OF ANY CITY ORDINANCE
NOR tkMff IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HERE13Y M DGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAIION
GIVEN Is CqRR AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNE7NR2!,R1iPGE. e-to COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOM' THE WO K AUII�D THERECY, NO PERSON WILL BE EMPLOYED
RI
IN VIOLATptj-"E LABOA DE OF E OF WASHINGTON RELATING TO
I
CV
S,qAft8AT!9I(INSURANCE 18.27.
WORIG�EA , .
R V DATE SIGNED
AGENT)
$ L:�(/() .- -
Description FEE Description FEE'
Plan Check
State Surcharge
Building Perff A
city Sur a
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
—
Recording Fee
Receipt #
CALL
FOR INSPECTION
APPLICATION APPROVAL
TNs &WIcatIon Is not a permit until signed by the
Building OMcW or hWMr Deputy: and Res are paid, and
fft0IPt 13 acknowedged in opm provided.
Accl "DC 0 E
ATTENTION
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
04/02 PRESS HARD -YOU ARE
1425%
I. �Fj
771-0220 'R DATE
EXT 1333
GINAL-FILE YELLOW - IN96ECTOR"
-OWNER GOLD -ASSESSOR
41 GREEN - ACCOUNTING
E
I
z
0
=i
0
M
:i:fi
ra �
M
M
0
80
C
�c
M
0 _n
M M
Q)
6 Fr,
In 0
z
0
4
0
M