20030789.pdfDATE RECEIVED
C17Y OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINME OF BUSINESS
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MAILING ADDRESS
2-2-o J\AAIN 5�7
CITY ZIP TELEPHONE
6DVA01"bS e I Li 2-Y-- -7
NAME
r= L
ADDRESS
CITY ZIP TELEPHONE
USE
ZONE
JOB
ADDRESS
I PERMIT EXPIRES
PERMIT
NUMBER
PLAT NAME/SUBDIVISION N
LOT NO.
LID NO.
LID FEE $
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
UnderWourid
Whing required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REOUIRED
YES 0 NO E3
z
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
R
NAME
—
:5 EL E
ENGINEERING REVIEWED BY DATE
ADDRESS
_ajjw!gp�
CITY
ZIP TELEPHONE
FIRE REVIEWED BY
DATE
W
STATE LICENSE NUMBER
EXPIRATION DATE CHECKED BY
VARIANCE OR CU
SHORELINE OR ADB* INSPECTION BOND
REO'D POSTED
I 1$
DYES 13NO
PROPERTY TAX ACCOUNT PARCE No.
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
NEW
RESIDENTIAL PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LIRSIDE REAR
ADDITION
COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL
muLnFAmiLy
PARKING
LOT AREA PLANNING REVIEWED BY DATE
SIGN
ROVIDED
REPAIR
GRADING FENCE
CYDS
t _ x FT)
REMARKS
DEMOLISH
TANK OTHER
GARAGE
REIAINING WALL 0 F RE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
I[TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
_
K� TYPO ONV ANT
RUCTION CODja._ OCCUP
/1 0004 7 GROUP
1
NUMBER
OF
STORIES
NUMBER OF
DWELLING
AREAS
CRITICAL .14
SPECIAL INSPECT] ON
1119.1—
OCCUPANT
_Z
UNITS
NUMBER
REQUIRED YES
JAREA
LOAD
DESCRIBE V 1`0 DNE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
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$
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE
I
GLAZING %
LOT SLOPE %
------
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I.EL027-,
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
Rilar,hanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN
Grading
3
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
1=
SEPARATE PERMISSION.
2
15
1
PERMIT
Engr. Review
APPILICATION: 1180DAYS
11 ILIMM I YEAR - PROVIDED WORK IS 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 WE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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 MODIFX
Landscapeinsp.
WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
MI
Total Amt. Due
I
I
Recording Fee
Receipt # tvsoz
a
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GWEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
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 Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
COMPENSATION INSURANCE AND RCW 18.27.
_W�EITS
-
OFF S SIGN RE DATE
SIG GENT) DAT SIGIED
(4,251
1
0 0-25
Ep 1
771-0220
-- 4�_ - - - - -
-
R A
ATTENTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD-ASSESSOn
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
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M
ATE RECEIVED
.2 PERMIT E X1
9 1 USE PERMIT
ZONE 1*11
CITY OF EDMONDS 411A___0 NUMBERCO&05�6 _1�_I?Fq
I inn AUITE1APT#
CONSIR C IONPERIVIII ArrL1L;A11UN
0 OWkER NAMEftWE OF BUSINESS
NAPNANNIF I)AM /OCFAt\) NAkL-
MAILING ADDRESS
wNER
"LINC
F12_2_0 MAW '5�7_
CITY ZIP TELEPHONE
r- -7 -7 S'_ D
e DIM 0 N DS q
E
F.- L F
ADDRESS
CITY ZIP I ITELEPHONE
NAME
ADDRESS
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER
I
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
0 REMODEL
[3 muLnFAmiLY
[3 REPAIR
GRADING CYDS
DEMOLISH
[3 TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
M?E OF USE. BUSINESS OR ACTIVITY1 EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
STORIES
UNF
DESCRIAP I TO RE
DONE
-77
)K(M1P.0qE7)T
N
ADDRESS ,,Ua AAM-1 -
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP
I ESCF Approved
RW Porrrill Required
Street Use Permit Reld
EXISTING — PROPOSED
hupection Required
Sidewalit Required
REQUIRED DEDICATION— FT
WhingrequIred 13
METER SIZE
LINE SIZE
I
I NO. OF FIXTURES
PRV REQUIRED
I
YES 13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
FIRE REVIEWED BY
DATE
DATE
SHORELINE OR ADB# INSPECTION BOND
DATE CHECKED BY REO*D POSTED
SEPA REVIEW SIGN AREA 10YFs 13NO IS HEIGHT
COMPLETE . EXEMPT I ALLOWED . PROPOSED I ALLOWED , PROPOSED
LOT COVERAGE I REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR I FRONT LJR SIDE REAR .
COMPLIANCE OR
0
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
SIGN REO'D PROVIDED
I I I
FENCE —
( X FT) REMARKS
o OTHER
FIRE SPRINKLER
0 FIRE ALARM
CHE;;7� �YTYPEq�ON TRUCTIO CODA_ — OCCUPANT
/7-7 GROUP
/_12 Z �4 "1
/I —1 1-- _.
CRITICAL OCCUPANT
AREAS SPECIAL INSPECTION
JAREA
NUMBER VZk REQUIRED LOAD
V
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REW
9
I
i;
GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONILX ANY CONSTRUCTION ON THE PUBLIC
DOUAIN (CURB$, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 160 DAYS
PERMIT UUrr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PEPJArr 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 REQUIREMEUT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICArION: THAT THE INFORMATION
GIVEN Is 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.
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
WORKMERS COMPENSA71ON INSURANCE AND RCW 118,27.
21&grfj
Deacription
FEE
Description
FEE
Plan Check
State Surcharge I
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
5
Recording Fee
Receipt #
CALL
FOR INSPECTION
(4�5)
771-0220
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building OffIcial or his/her Deputy: and Face are paid, W
receipt Is acknowledged In space provided.
OF 6 =SIG T RE I DATE
--RYLEA§ED'AY IDAVE
ATTENTION I I t:x I IJJ
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 YELLON-INSPECYOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING