20030788.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
10, 0 15;
CITY ZIP rELEPHONE
C-4wtiv> q% D
NAME
ADDRESS O/A
CITY I ZIP ITELEPHONE
NAME
nsoA
CBL�
I OL
ADDRESS
CITY
'c'"A- Mv
ZIP
TELEPHONE
074 4 vo 1, 5 5 1-7-
ATIO
STATE LICENSE NUMBER EXPIR, N DATE
(9 1- c, 0 0 f .4 74 k 05
PROPERTY TAX ACCOUNT PARCEL NO. 00
011
1-:2 0A_ I
0071%
NEW
RESIDENTIAL PLUMBING if MECH
ADDITION
COMPLIANCE OR
COMMERCIAL CHANGE OF USE
REMODEL
MULTIFAMILY SIGN
REPAIR
GRADING o FENCE
cyns X FT)
DEMOLISH
TANK o OTHER
GARAGE
CARPORT
RETAINING WALL F RE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS
f:��
OR-ACTIVITY11 EXPIAlft
I V f1w !�� - .
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE %tlsf�vi, A A6vJ
69--
&-kS �V"A64,:� OAM�-L
1;6C'-0FAD_1D-17-- 1 -7011000 9114- .
-ru i e4
9_q1V A- 47,, 00 o 6
�AvNt�V4 kDJVL Od AA*1lJ PWOK
HEAT SOURCE- GLAZING LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICATION: 180 DAYS
PERMIT ILIMM 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
EDMONDS. WASHINGTON. ITS OFFICIALS. 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 LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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
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'SjCPGkN9ATION [!��E AND RCW 18.27.
A
��=2EPL':OR A DATE SIGNED
(&,� 1-n .'7 - 01-7
PERMIT EXPIRES
I -
USE PERMIT
ZONE NUMBERa)i,,,,,�
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LID NO,
77 LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Requited
Street Use Founit Req'd
EXISTING Lred
I usd
LIM1. !=q�!Akg%WM1fCLW` 'U"
YES NO 13 z
z
_J I I
agAEaWAU3j.&FQWEROON)N-CMTRUEJURAINAUt I
ObtalnElectrical Pemit from
-IRE DATE W
*'.Labf)r & Industries cc
M
VARIANCE OR CU SHORELINE OR ADBN J INSPECTION BOND
REO'D POSTED
13YEs ONO IS I
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED , PROPOSED
E 61 ETBACKS (Fr.)
MOMMI) TORSIP SIDE REAR 0
in Le
is open or sed, expans ks are z
Moved o I' A-W ;VM6fiIURK%-WBY DATE
C 'RC
K edg. I ECDC 1 .30.020 (c)
CHECKED BY ITYPE 17n nIN Cqlr-
OCCUPANT/19,�5
GRO
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
'A
$
Description
FEE
Description
FEE
Plan Check
State Surcharne
Building Permit
City Surcharge
Plumbing
2L
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt 0
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
2
CALL
FOR INSPECTION
1A
1-125)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
BuIding Official or hisltier Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
OFFICIALS S 0 'ATURE 9ATE
./
k
RELWEb'df / DAIE
ATTVNTION LA I I j
IT Is JfNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLON- 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
3
z
9
0
M
fn
C
M
C
M
C
z
0 In
"I M
C
r
M 0
z
z
0
M
-i
14
YDATE RECEIVE:��t,�
[PERMIT EXPIRES
W
USE PERMIT
ZONE :3 —0
CITY OF EDMONDS NUMBEF12W_
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 00 1 5 1� � 1-"' A " 4�_- - W
OWNER NAME/NAME OF BUSINESS -1 PLAT NAME/SUBDIVISION N77 LOT NO. LID NO.
I. t:�_ vi—j
MAILING ADDRESS LID FEE S
TESC
V� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw P=tiql1led
+ V-9 Street Use Pamilt Reld
CITY ZIP ITELEPHONE EXISTING — PROPOSED Inspectlon Plaquired
AWsombftuired
Undergrountli
R Fr
Wwoo requ*d
NAME IS [OCINIKIZ IXTU FRV QUIRED
16 16MVIbb NO 13
requiref on fuel-birldilig UP
81
ADDRESS 06 spacm UIVI%,
0 1", e R RESPONSIBLE FOR EROSION CON E
tj A
CITY ZIP
NAME CBL
0� ENGINEERING REVIEWED BY DATE
ADDRESS
AA FIRE E1ecU1CQrPe'r75M liwmw z
CITY ZIP TELEPHONE T 2r & IndustrIPq
0� Do 0
VARIII CEORCU SH A BOND M
STATE LICENSE NUMBER EXPIRATION DATE Wa"L+_"REQ'D POSTED
q 113YE is
o I- S () 1-4 4. os SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
7,1
k 01I Q 0 ka \00 EXP
...............
LOT COVERAGE REQUIRED SETBACKS �FTI PROPOS (Fr.) M
NEW RESIDENTIAL PLUMBING MECH ALLOWED 1E EAR
COMPLIANCEOR
ADDITION COMMERCIAL Regar*ss of whether the water system.�
0 CHANGE OF USE
PARKIN T UNA E C01 I M
REMODEL. MUL11FAMILY SIGN REQ`D PR IDED er M
d on hot water tanks Per 10:
GRADING o FENCE I r
REROUR 0 CYDS ( — x FT). REMARKS cq
DEMOLISH 0 TANK OTHER If
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM 0
d
.(TYPE OF USE. 61.16INESP OR.ACTIMO EXPLAIN:
CHECKED BY ITYPE C I N OCCUPANT
GROUP
NUMBER NUMBER OF CRITICAL
OF , DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
STORIEE UNITS NUMBER REQUIRED [] YES LOAD 0
o Fn
DESCRIBE WORK TO BE DONE r_
A W R,EMARKS 2
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG�D 0
CALL 6 �- G- A- S � %1 "A 64,"
A AW NEW
1;12i�t A DI 0 -1'4- 10,000 1?_rLj1_ X
VALUATION I IM ME 11—ft OW
z
0 C) 9-ru 1 $
LAVNtSV4 0-oom v /4 AAA-( I -no K... Description FEE Description FEE
z
Plan Check State Surcharge
HEAT SOURCE-' GLA23NG % LOT SLOPE % Building Permit City Surcharge .000, 0
Do'
$State
City.
PLAN CHECK NO- VESTED DATE
Plumbing
Mechanical
IT AUT140 KTO
THIS PERU RIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRWATIE PROPERTY ONV4 ANY CONSTRUCTION ON THE PUBLIC
'QqMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION. ISO DAYS
66IMIT UMM 1 YEAR - PROVIDED WORK 16 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 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND HINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECnY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PE MIT SHALL NOT BE Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 18 CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPIY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This applicallon Is not a permit until signed by the
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Foes are paid, ancl
IN VIOLATION 91_1HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION[ receipt Is acknowledged In space provided.
WORKMEW!jf!PqSA71ON D RCW 18.27. ATE
OFFIQA8j S' I GI AT�U R E
C
'fAd3ff-_% /,)( A
BIG RE E A DATE SIGNED
D�7 165R
771-0220 rRELEIASHIVVU/ _T —DAf E
ATT NTION Off 1333
IT IS LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
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