20030764.pdfDATE RECEIVED
LPERM�IT EXPIRES
ZONE PERMIT
CITY OF EDMONDS NUMBER ��7171?
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JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 00 ILI
OWNER NAMEINAME OF BUSINESS 10 Avr
73"PIi, c V, A, os,� PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
15 MAILING ADDRESS LID FEE S
TESCP Approved
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PefrWt Requ ed
—j 0 o LA 0 Ave- tj Street Use Peffn RKd
EXISTING — PROPOSED Inspection Requited
CITY ZIP TELEPHONE Sidew&Ik Required
Under610's d
1) Wk 0 k, 0 REQUIRED DEDICATION— FT Wiring required
NAME METER SIZE LINE SliT NO, OF FIXTURES PRV REQUIRED
YES El NO 13
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
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STORIES UNITS NUMBER
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REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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Descri Ion
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FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE LAZING % LOT SLOPE %
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Building Permit City Surcharge
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PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
2 TC.) WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, E
SEPARATE PERMISSION.
Engr. Review
PERUrFAPPUCATION: 1180 DAYS
cL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection �T)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review Plan Chit. Deposit
IN INTEREST, AGREES TO INDEMNIF% DEFEND AND HOLD HARMLESS THE CI1Y OF
EDMONDS, WASHINGTON, ITS OFFICALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
ALL CLAIMS FO ' DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSIJANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp. Total Amt. Due
DEEMED TO MODIFY; WAIVE OR RE13UCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
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
THE OWNER. I AGREE TO COMPLY WITH CRY AND STATE LAWS REGULATING CONSTRUC-
CALL This application Is not a permit until signed by the
TION; AND IN DOIN E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF H R�QODE OF THE STATE OF WASHINGTON RELATING TO
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Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION1 receipt Is acknovAedged In space provided.
WORKMEN'S COM N INSIRANCE AND RCW 18.27.
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IG RE ENT) DATE SIGNED
(425) e0ol, :3
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771-0220 _�`E _LE
A S E D-BY'
ATTENTION
M 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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RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
7T� C. V,
MAILING ADDRESS
—L 0 Q L4 N
CITY ZIP TELEPHONE
E Dmoki Q
NAME
ADDRESS
CITY
NAME
Cj )vv\ rv, wL
ADDRESS
P 0
CITY
ZIP ITELEPHONE
NCO
ZIP
5-( /W LAJ C) 0 0 9 �61M
STATE LICENSE NUMBER
ft—OMIV, up �
CBL #
Ill C-1
TELEPHONE
-t . - 'L's 0 0
..J:, 0 (' 'S 7
EXPIRATION DATE J, C""_2*""
0- 6 li (I Wd
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
[3 COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULnFAMILY
SIGN
REPAIR
[3 GRADING
CYDS
0
FENCE
( X—FT)
I
DEMOLISH
TANK
OTHER
oGARAGE
RETAJNINGWALL
F RE SPRINKLER
ALARM
CARPORT ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVn EXPIA"
FIRE
L--- Ir I
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORT( TO 112756NE
PERMIT EXPIRES
USE PERMIT f
ZONE NUMBER Ifm 07
J013 sun
ADDRESS
10 0 10 Avr
PLAT NAMEISUBDIVISION NO. LOT NO.
LID NO.
LID FE S
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
Underwound
Wiring required 13
METER SIZE
LINE SIZi7
NO. OF FIXTURES
P REQUIRED
rYE
NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE
PURSUANT TO UPC 605.2 rL
an
WAM son
VARIANCE OR CU N&r"Dfk_JMW D
FN TWTED
SEPA REVIEW
SION ARFA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
I I
ALLOWED PROPOSED
I
EXP ,
,
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROP06ED
FRONT SIDE REAR
FRONT IJRSIDE REAR
PAIKING
DATE
E9
RECID PROVIDED
IM
Z=9RWULAMRY&U(W0
"ION 0.
W Y! 9. 3 0.020
REMARKS SHALL
BE INSTALLM NEL4R
MEN
CHECKED 13Y ITYPEA CTI
��T ON
OCCUPANT
GROUP R
SPECIAL INSPECTION rEA_ OCCUPANI
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REGfD
Im M M Mir W l@V1l10 � wasKrumar-
VALUATION
$ 1
Description
IVII-661611
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE T_ GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
see'VeNs
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
k: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
2
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVIEWAYS, MARQUEES, ETC.) WILL REQUIRE
:1
';,,
t: SEPARATE PERMISSION.
-
Engr. Review
PERMITAPPILICATION. 1180DAYS
PERMIT ILIMIr I YEM - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
qEJE "CkQF?INK PERmrr MR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
qynj�hk. Deposit
)IT -INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Pecelpt #
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
Landscapelnsp.
.
Total Amt. Due
ME,
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
A
-
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT 7HE INFORMATION
APPLICAICION APPROVAL
GIVEN 19 CORRE" 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
TIOW. AND IN DOINQJHE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Oftiall or his/her Deputy: and Fees are paid, and
IN VIOLATION 0 H DE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknovdadgad In space provided.
WORKIMEITS CO RANCE AND RCW 18.27.
OFFICIALSIU/4 ATE
8 S un
BIG RE DATE SIGNED
r
13
771-0220
RELEASEffI3Y LIATE
ATTENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE I!NTIL
...........
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEAYIFI:
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE YELLOW - INSPECTOR
PINK-OMER GOLD -ASSESSOR
04/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
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