20030812.pdfDATE RECEIVED
e
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
_obe,k &,4 T", 4A T4*t%"
MAILING ADDRESS
I /Po ?-- -I 10-
CITY TELEPHONE
&Y"Ug" sbzv,p, PT Wei (M Mq-
NAME
ADDRESS
ZIP IT.ELEPHONE
NAME -rom
ADDRESS
AL100 M4,44 liqc�
CITYf ,kATELEPHONE
'STATE LICENSE NUMBYR EXPIRATION DAT
fiv&0A1 J-'1,-o21&Z& ZA
4��r
1A In 6443 04rd(b
NEW
zr RESIDENTIAL
1:1 PLUMBING/MECH
0 ADDITION
1:3 COMMERCIAL
aREMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
0 ( _ X_FT)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
El ROCKERY
o FIRE SPRINKLER
FIREALARM
(TYPE OF USIF. RIIPJNESR ORACTIVrrfLPPL&W-
NUMBER NUMBER OF 1ITICAL
OF DWELLING AREAS
STORIES I 1 0 1
UNITS NUMBER
DESCRIBE WORK TO BE DONE
-V -7
SE
ZONE Cf, 21
I PERMIT EXPIRES
PERMIT
NUMBER r,)_41)
JOB
ADDRESS
1�05 L±
AL
SUITCIAIrr'
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT 01 WAY PER OFFICIA STREET MAP
TESCP AV'
flW R'
d
EXISTING PR D-,
Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
Undo(WMM
Wiring required
METER SI�E
LINE SIZE
7, OF FIXTURES
PRV REQUIRED
13
X
3�
�3
YES NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
&4ez+M'3 Cl)
A) owe, Itq 44 0"A.m .;;ft4r
(D7 d 44
In a-- -A � - /,
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
e`IEC18
POSTED
-7,
5Q
yrz� NO
S
$*5
SEPA REVIEW
_'9FGN AREA -
HEIGHT
COMPLETE EXEMPT
LLOWED PROP SED
ALLOWED PROPOSED
, X
P40
_XP
TA&A P-X—" rr
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKY(FT)
ALLOWED PROPOSED
F@N7 SIDE REAR
F REAR
UR SIDE
PARKING
LOT AREA
PVNNIVG REVIEWED BY DATEd
REO'D I PROVIDED
I r) 10
( 1v
CHECKED BY ITYPE
Lu
—SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES I LOAD A
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'
A TION
_i2LLX> I Ale t)v) I-r*
Description FEE
DescripUon FEE
r4741
jUeSi, LOT—, Plan Check . Rate Surcharge
SOfJRCE` 13fAZ1T4G % LOT SLOW9
tEAT L. Building Permit City Surcharge
PLAN CHECK Nfl. VESTED DATE F, Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THI 'OVE S WORK To
tz BE DONE ON PRIVATIE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. ALARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION.
t:! Engr. Review
PIERMITAPPLICATION: 160DAYS
PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. lnspedon'�p
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAK 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
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE > Total Amt. Due
91 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapoinspf
0 NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt N
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Feen are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided,
WORKMEN'! AQMPENSATION INSURANCE AND RCW 18.27. DATE
a__ OFF SIG IRE
DATE SIGNED
SIG= OR AGEfM 1.4-25)
771-0220 REkQSED BY DATE
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
i , 6,9
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
z
CL
M
C
rn
-48
0 C:
:� C
M M
0 -n
n
M M
a Vi
0
6 Fn
C8
C
MO
z
z
9
0
ITI
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: wwdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
C. 8C)" Planning Building Engineering
July 13, 2004
Key Bank
Derrick Tan/RM
4401 168h Street SW
Lynnwood, WA 98037
Re: Performance Frozen Fund Account #472924003792, Noel and Patricia
th
Johnson, 22005 76 Avenue W, Edmonds WA
Dear Sir or Madam:
The City of Edmonds hereby autho rizes the release $30,658.00 from the above referenced
ai an ce
Performance Frozen Fund. The remaining $5,410.00 is to be held as a site m nten
fi-ozen fund which must be held in place until written City approval has been sent to the
P.
financial institution, authorizing release. All interested City departments have approved
of the Performance Frozen Fund.
the partial release
Sincerely,
te
Hajms*o
Permit Coordinator
Cc: Applicant
File
Uremp/DST's/MwtcrLttters/PelmcPcrformanccO2/01
Incorporated August 11, 1890
Sister ON - Hekinan, Javan
Dear Sir or Madam:
erenced
Edmonds hereby authorizes the rele ase $3,189.00 from the above ref
The City of
Performance Frozen Fund. The remaining $563.00 is to be held as a site maintenance
froz fund which must be held in place until written City approv at has been sent to the
en
financial institution, authorizing release. All interested City departments have approved
ormance Frozen Fund.
the partial release of the Perf
Sincerely,
Permit Coordinator
Cc: Applicant
File
IJTcmp/DST's/MasterLcaerstReleasePerformanccO2/01
Incorporated August 11, 1890
Sister ON - Hekinan, Janan
FM.,-tL PROJECT APPROVALA'ORM
0
TO:
DATE:
a
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sipature
I:temp.bldg:forms:ocaprvl 3/25/04
z
9
0
M
=i 9
am
c
mo
0
80
c
M
MZ
g) -i
0 -n
n
m M
0 V5
0
0 Fn
C 0)
c 0)
M 0
-Z l7n
M
z
--I
X
V5
z
0
m
FINA.T-PROJECTAPPROV WPM
TO:
DATE:-
z
0
rn
=i 9
m
ma
0
80
c
Ic
MM
MZ
10-1
CM
o -n
A
4
m
m m
a
0
0 M
C cl)
c (1)
M 0
Z
7-1
M
—1
z
0)
z
9
0
m
2..
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL'
Si
Date
oc&prvLdoc.l:h=p.-bWr-fom10/01
FlNt..j_'j PROJECT APPROVAL I jRM
TO:
nATlP-
z
9
0
m
=i9
us -M,
am
a
mo
0
-10
oc
-4 C
X M
M Z
co
0
n
m m
0
0
0 M
C ca
c co
M 0
Z
M
--I
3:
z
z
9
0
m
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECTAPPROVAL
Date Signature
I:Wmp:bldg:forms:ocaprvl 3/25/04
4 .
PATE RECEIVED
'2�- 1(,,'). PERMITEXPIRES
P1101711 dzila 1 77 7-7727—
PERMIT
ZONEM,
CITY OF EDMONDS NUMBER
JOB SUITE1APT-fi-----7Aw#
CONSTRUCTION PERMIT APPLICATION ADDRESS 14065,
OWNER NAMEINAME OF BUSINESS I " A,�,_
�&F'_k al,4 jo_�Ivl PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
JLING ADDRESS I LID FEE S
1ESCP,VPn0—
PUBLIC RI PER OFFICIAL STREET MAP RW Parrnit Required
PI. 0 Street Use Poffnit 1100
TY ZIP T EPHO EXISTING PROPO D Inspection Required
NE Sidewalk Required
i� Underground
;.I -A RE411iikl) DEDICATION- FT Wiring required
rNAME METER SI.Z�,, LINE SIZE [ NO. OF FIXTURES PRV REQUIRED
-B YES (3 NO
ADDR—ESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
014
ZIP ELEPHONE 18,50ee�' Q) (?M>1 (�O -hci!�Vlld
-7 st4A,;1I A
IT
"I', NAMIE- CBVN,
EAGINEERING REVIEWED SYVV 'DATE
9C ADDRESS
Ait-loo H"4 49 FIRE REVIEWED BY DATE
CITY TELEPHONE Z-02 ]'MW6
&4,m 6ftel, � "�y 11 X_ /) VARIANCE OR CUI SHOREUNEORAD130 INSPECTION BOND
STATE LICENSE NLIMBER EXPIRATION D ECKE BY ��REQ-D POSTED
S 13NO S-57T
te, SIGN AREA HEIGHT
BEIRA REVIEW
PROPERTY TAX ACCOUNT PAR EL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
C
T 0 EXP 1_40&k�cl_o
LOT COVERAGE REQUIRED S PROPOSED SETIBACKY(FE)
0 NEW RESIDENTIAL PLUMBING/MECH SETBACKREAP FRONT WR WE , REAR
ALLOWED PROPOSED FRONT SIDE "t "
COMPLIANCE QEL I C5 I — 4: 1. 1 z 115,1, 1
. z
ADDITION COMMERCIAL ^4�� I
PARKING LOT MREA PLANNI�G REVIEWED BY OAT . 916
REA
R
REMODEL MULnFAMIl.Y 0 SIGN REOID PROVIDED
GRADING FENCE 0 Flz)� o
fj REPAIR CYDS X FT) REMARKS
OTHER
DEMOLISH [j TANK
4
11 0 GAWE rj 13ETAINING WALL F RE SPRINKLER . I . .
C*ORT, t_J ROCKERY FIREALARM
l(TYPE 'USE JIMMESS OR ACTIVITYLEXPLAIN' CHECKED BY ITYPE F CONSTRUCTION CIE-
IE�b"6 —, 17F:F=l _� OCCUPANJI�3
f 6 -GROUP
NUMBER, CRITIC . -1 1
'OF NUMBER OF AL OCCUPANT
DWELLING AREAS SPECIAL INSPECTION JAREA
ST6 RIES UMTS NUMBER REQUIRED 0 YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOD�
M. '71D &4W111.VaAAff
VALUATION
4 69
flon
1139scirlloio... FEE Description,- FEE
PI eck State Surcharge
4' , �an Ch
'HaT' SOURC?
Pn City Surcharge
Aullding Permit
E FIC - .
PLAN CHECK N VESTED DAT ff= Plumbing qW
A/27 401 AA
Mechanical
THIS PERMIT AUTHORIZE0 ONLY THE WORK NOTED. THIS PERMIT COVE444 WORK TO
11-- BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THEPUBLIC Grading
2 DOIIMN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
PERUFTiPPLICAiloN. 13;()QAYi' Engr. Review
ERMIT UMM I YEAR - PROVIDED WORK IS STAR11ED WITHIN 180 DAYS Engr. Inspection2"V,
SEE BACK OF PINK PERMrr FOR MORE INFORMATION
"'W011LICAW, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Cho. Deposit
IN INTERE , ST.AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # t
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 '-0jgEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeIns tc Total Amt. Due
N601RA SION.'
IN ANY WAY THE crrys ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APP CATION APPROVAL
GWEN 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- CALL This applicadon Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Offlclal or his/her Deputy; and Fees are pald, and i,
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION fecelpt is acknowledged In space provided. i,
WORKMENSLQMPENSATION INSURANCE AND RCW 16.27. RE DATE
�OF!F gC, 2�
19=11111 DATE SIGNED JC S I G17/ E
SIG E (0 R OR AGENT) 1,425)
771-0220 4SED BY DATE
Lj
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL f
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
z
9
0
M
M
C
ME
80
C
-1 C
AT
10--I
C -Z
4
0
E� c
ITIM
a
0
0
Fn
C (a
z ca
rn
co
z
9
0
M