20030758.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBL#
113.5
ADDRESS
63,33 6,a1t&vd
CITY ZIP jELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CH BY
5L4'TT4F/jjf1'32-)1"
PROPERTY TAX ACCOUNT PARCEL NO.
00 Af 2-2-Cl 0000 if a I
1:1 NEW 031"RESIDENTIAL 011PLUMBING / MECH
COMPLIANCE OR
ADDITION COMMERCIAL 1:1 CHANGE OF USE
REMODEL MULTIFAMILY [3 SIGN
REPAIR GRADING [3 FENCE X
CYDS FT)
DEMOLISH 0 TANK OTHER
GARAGE -1 RETAINING WALL FIRE SPRINKLER
CARPORT [3 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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PLAT NAME/SUBDIVISION NO.
PUBLIC
PERMITEXPIRES
PERMIT
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NUMBER
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LID NO.
LID FEE S
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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DATE
FIRE REVIEWED BY DATE uj
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GAS PIPE TEST MUST BE
VARIANCE BOND
cOHISERMEBYOCiTY IRMN POSTED
SEPA REVIEW- -_ -
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PROPOS
ALLOWED ED
COMPLETE EXEMPT
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
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LOT AREA
PLANNING REVIEWED BY DATE
PROVIDED
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REMARKS
NUMBER NUMBEROF DRITICAL
OF DWELLING CAREAS
STORIES &911UNff8 Of
DESCRIBE WORK TO BE DONE .0 /1' �, )'j I
4
HEAT SOURCE GLAZING % LOT SLOPE.20
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZEV ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a DOMIUN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPILICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS OR 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 REDUCS ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HERE13Y 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'S COMPENSAT NCE AND RCW 18.27.
I URA
SIGNATURE �DWNER
DATE SIGNED
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CHECKED BY ITypE qpMy%TpU4gW . E/ U
4CO/D 4) 1 OCC PANT
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SPECIAL INSPECTION JAREA LOAD
REQUIRED [] YES I
PER USC 108/FINAL INSPECTION REQ'D
$
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Description
FEE
-
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
MFEE
Plumbing
Mechanical
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Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapoins P-1
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy; and Fees are paid, and
FOR INSPECTION
receipt Is acknowledged In space provided.
OFFICIALS/IG N7A,,URE
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771-0220
RELEASED BY DATI!
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 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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ON PERMIT APPLICATION
OWNER NAMEINAME OF
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MAILING ADDRESS
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CAAONcAof 17,024 1 7 79 — 001 f
NAME
ADDRESS
PERMIT EXPIRES
US E PERMIT
ZONE NUMBER 75,4
JOB SUITE/APT#
ADDRESS 1 1?8 12. Ff 4C4,.L_ CX417
PLAT NAME/SUBD[VISION NO. LOT NO. LID NO.
LID FEE $
TESCP APPrOvOd
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW PeriNt Requkod
I __ PROPOSED Wd
UQbAWAIr11=tr1W1TPeMAt fk
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REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAIN AGE
CITY ZIP TELEPHONE
CO1
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WAME 1/35 ENGII E80=005[118CM UMG DATE
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ADDRESS I
67-33,3 FIRE REVIEWED BY DATE
CITY ZIP jELEPHQNE
G IFS1 MUSLU."
VARIANC61ft Ntftyl BOND
ST ATE LICENSE NUMBER EXPIRATION DATE HEC By R OCR POSTED
. . e!b L4 -r -r E a Al 1.% -2 ) M 611joar I a 10raff. -QUA111 IS —
PROPERTY TAX ACCOUNT PARCEL NO.
2.1.4% 0000 if 01
SEPA ' '
COMPLETE EXEMPT
EXP
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NFAM6
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L!
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HEIGHT
ALLOWED. PROP OSED
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RE RE
LOT COVERAGE QUIRED SETBACKS (Fr.)
0 NEW 70RESIDENTAL ept. UMBING/MECH REAR
PROPOSED SETBACKS (FT.)
LIR SIDE REAR'
ALLOWED )PO
PROPOSED
FRONT SIDE
T
FRONT
ADDITION 0 COMMERCIAL
COMPLIANCE OR
1:1 CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL 1:1 MULTIFAMILY
0 SIGN
REO'D PROVIDED
[3 GRADING
0 REPAIR CYDS
o FENCE
( FT)
REMARKS
DEMOLISH TANK
OTHER
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f
GARAGE RETAINING WALL
F RE SPRINKLER
U CARPORT IU ROCKERY
U FiRE ALARM
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P PPE,BUSIW. J)fl,�CTIVI73 EXPLAft;_,
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TYPE�
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OCCUPANT
NUMBER ANUM
OF
ER OF
DWEBLUNG
rCRITICAL
AREAS
SPECIAL INSPECTION JAREA
OC&J PA�4
STORIES
UNITS
NUMBER f4f
REQUIRED 13 WS
LOAD
DESCRIBE WORK TO BE DONE A
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pj�)
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REMARKS
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-
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION
11 . a a T-AAJ 90 12. �A & K& .1" 1
V
YX
HEAT SOURCE GLAZING % LOT SLOPEj
PLAN CHECK NO* VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMMN (INJRBS, SIDEWALKS, DRIVEWAYS, UARQUEES, ETC.) WILL REQUIRE
:SEPA3NATf.P9ft90SION.'!
PERMIT APPLICATION: 180 DAYS
PERRAIT LIMM I YEAR - PROVIDED WORK IS STARTED WTrHIN 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 OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
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 REOUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
OWEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CRY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABQA CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSA��NSNURANCE AND RCW 18.27.
SIGNATURE EA OR DATE SIGNED
q/2.1,103
_A
$
Description FEE Description
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Inspection
Fire Review
Plan Chk. Depo
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt It
APPLICATION
APPROVAL
CALL
This applicaflon Is not a permit until signed by the
Building Oftial or hWher Deputy: and Res are paid. and
R INSPECTION
receipt 13 acknovAedgod in space provided.
OFFICIALS&IGNATURE E/
(4231
771-0220
RELEASED BY I IDATjIf
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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