20030865.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
1-nii/Car.l.ene Mi-lone
MAILING ADDRESS
9008 218th St SW
CITY ZIP TELEPHONE
EDmonds 98026 1425-776-8996
NAME
ADDRESS
CITY
NAME
ZIP ITELEPHONE
ADDRESS
12601 132 Ave NE
CITY ZIP
Kirkland 98034
STATE LICENSE NUMBER
FASTWHCO52DF
PROPERTY TAX ACCOUNT PARCEL NO.
CBL #
TELEPHONE
425-814-312
EXPIRATION DATE BW
2-16-05 (VU
NEW
NKRESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULnFAMILY
REPAIR
0 GRADING CYDS
DEMOLISH
TANK
oGARAGE
CARPORT
o RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS OR A
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
PERMIT EXPIRES
U PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
r .... 218th—St SW
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP A
RW Perm
street use Perm d
EXISTING PROPOSED
Inspection R tdred
ad
REQUI - - �r
lf�
111� 13
METE SWD LUNNAff-l-l' 'WO.'O FIXTURE§
PRV RfaUIRED
St Labor Industr
,j
YES 0 , NO z
REMAR S
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
nugaigiess oT wnp,.�::,- e N:jor
is open or dosed, expansion tanks 1
VO4WWEan all hot water tanks PINT E
FIRE REVIEWIzq-]!f�
VARIANCE OR CU SHORELINEORADB# INSPECTION BOND
I REQ'O POSTED
IT
3j.T.WM.,'R hi..i,�gg&L'aametWn.rn":""'P'R&OSED
EXP I 4;quiredointuel-$t.-.�.-,Lltxgn)pliauci�in
LOT -_ . 1 .0 104&ED SETBA'
PLUMBINGIMECH %wamat waamry��
ALL,WEIOWMO,,De( FRONT SIDE REAR FRONT LJR SIDE
COMPLIANCE OR
1:1 CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY
0 SIGN REQ`D I PROVIDED
IFENCE
3 ( _X FT) REMARKS
[:] OTHER
0 FIRE SPRINKLER
FIRE ALARM I
0 N
PE
CHECKED BY
CRITICAL SPECIAL I
AREAS iNSPE [ON AREA
rI
NUMBER REQUIRED YES
er heater REMARKS
-IF
I
PROGRESS INSPECTIONS PER UBC I
�1� = � A WJAV�A WBIOAFM�.WY- lh_� Affff rlffff&V
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
NAL INSPECTION REO'D
VALUATION
$
449.00
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
1
Building Permit
City Surcharge 4�_
_ _L
PLAN CHECK NO: VESTED DATE
Plumbing
4C —
Mechanical
THIS PERMIT AUTHORRES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
X DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: 180DAYS
PERMIT UMrP I YEAR - PROVIDED WORK IS STAKMO 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
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
Landscapelnsp.
Total Amt. Due 69
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
zi
Recording Fee
Receipt #
/I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATI APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWN R. AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DICING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or histher Deputy: and Foes are paid, and
FOR INSPECTION receipt is acknowledged In space provided.
WORKMEN'S COMPENSAT��ANCE AND RCW 18.27.
OFFICIALS SIgNATURE DATE
SIGNATURE NER 0 DATE SIGNED
IA95)
A(O =AG
EN
771-0220
R I VASFb BY C CfATE
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-
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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