20030904.pdf0
VuI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
LING ADDRESS
CITY ZIP I TELEPHONE
SFAITL& are51A;?__111
; LZ
NAME
W dfi� + 11-bW 1_;6
ADDRESS
f WMSANJ61 ;/?�00
CITY ZIP TELEPHONE
e;E4me., M4 G
NAME CBL#
I,bNb HWY 1�& btb I /,
ADDRESS
CITY
I I -
ZIP TELEPHONE
51ZA I ". III
XPIRATION DATE
STATE LICENSE NUMBER
4,I)NI? -� - / /_
E
I L � �! - 7
'ClE PROPERTY TAX ACCOUNT PARCEL NO.
C) 102 v�� 0�
'71 NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
P<MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAININGWALL
CARPORT
ZI
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
. A. .. , ., . - . . _P .1,7 �, � . t,
NUMBER NUMBER OF
OF DWELLING
STORIES 77 1 UNITS
DESCRIBE WORK TO BE DONE
6
-7
PERMIT EXPIRES
6SE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS___7 i
/ _/�zz
PLAT NAMEISUBDIVISION NO. LID NO.
LID FEE S
TIESCP Approynd
PUB[ ' IC RIG!JT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Roq'd
EXISTING161ibLkrL�PROPOSED InGpection Required
Sidewalk Required
REQUIRED DEDICATION- FT Undeiground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I ___ I YES 0 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
C.
FIRE REVIEWED BY DATE
VARIANCE OR CU -INE OR ADSO INSPECTION 7OND
103 Y RECI'D POSTED
OYES
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
E] SIGN
FENCE
( X FT)
El OTHER
FIRE SPRINKLER
FIRE ALARM
ITICAL
EAS
MBER
�f
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECKr�- VESTED DATE
THIS PERMIT AUTHORIZES 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.
cc
LLI PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI.ESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IM
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT UBE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x 0 NOR LIMIT IN ANY WAY THE CITYS A131LITY TO ENFORCE ANY ORDINANCE PROVISION '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT YHE 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 V61-ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
SIGNrj (OWNER ZAGE�TI� DATE SIGNED
fi� 0 �19_pr "� V - - % I I I / -7 /
UJI
z
z
6
z
UJI
Id
SEPA REVIEW
SIGN AREA
naluni
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP i>4
+
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
b�
lic;4-
z
z
PARKING
LOT AREA
NNING REVIEWED BY DATE
5
CL
BE IDED
I
J.P z
Kvtuvc-e
REMARKS
Gpffl4b-D 'f�
e� e�� oz� Crt--l- L--.(
CHECKED BY JTYEV; OF CONSTRUCTION OCCUPANT.
IV GROUP
,%j " Y;9!ejwliq� 1. - 1�
SPECIAL INSPECTION AREA OCCUPANT
LOAD
REQUIREDE] YES
REMARKS
PROGRESS INSPECTIONS PER USC I 08/FINAL INSPECTION REQ1D ago
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
A17ENTION k:)(I
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
FEE Description FEE
III—je'l state surcharge
City Surcharge
PlanChk.Deposit
Receipt III
Total Amt. Due
Receipt
APPLICATION APPROVAL
This application is not a penrnit until signed by the
BUilding olficial or Iiis/ticir Deputy: and Fees are paid, and
receipt is acknowledged in space provided
FFICI SIG HE DATE
RF[.EASFD BY
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIUINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
z
0
i
0
M
--i -"
0 M
C
M 0
0
--i (-)
0 C:
M
M Z
_z
�x
U5
o -n
n X
>
MITI
06)
0 r-
0 ITI
C C0
?. Cn
M
Z
r
z
W
z
0
M
I
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ....................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
i
0
171
-n
3:
M
C
M
0
0 C
M,
M Z
01 1
C _Z
3:
(j)
0
n
M M
a Y)
0 r-
0 M
C 0)
C CO)
Q 0
Z
z
C/)
z
0
0
M