20030907.pdfI
DATE RECEIVED [PERMIT EXPIRES
U
CITY OF EDMONDS z
CONSTRUCTION PERMIT APPLICATION
A
OWNER NAMEINAME OF BUSINESS
PAV#0 P. tjA-r6tj P`09'0ir I GIERG�
MAILING ADDRESS
/ 0 a AV 61�
1460171
CITY ZIP
OIYIQS WA. ?Y020 I
TELEPHONE
(Jz�- 72(4-�S-00
NAME
f"zH All- On C- D6S),
DRESS
1577 15-OL; 'SF. -�4J
CITY ZIP
TELEPHONE
-79r-61233
NAME
RCH CL) S _rtZ(A C,
7
CBL 0
03417
cc
ADDRESS
r 0. 12 ('-f I
CITY zip
go cl)
TELEPHONE
STATE LICENSE NUMBER EXPIRATION DAT
0(/- � Z
C�UgCKED BY
1 ft) �/_
RCf1;ZC017_S7:f h
1
PROPERJY TAX ACCOUNT PARCEL NO.
006199603 o07 01
E
NEW RESIDENTIAL PLUMBING/MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL 0 MUI.TIFAMILY SIGN
0 REPAIR 0 GRADING CYDS o FENCE X FT)
0 DEMOLISH TANK OTHER
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROOKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS F
CRITICA
ARE S
NU BE
DESCRIBE WORK TO BE DONE
,
TO F 62 0,4 f 0 F (4-5 4K
HEAT SOURCE
kA
GLAZING %
N A
LOT SLOPE %
t4f
PLAN CHECK NO:
7 tJ -
VESTED DATE
THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
3
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
916
PERMIT LIMM 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
0I
M
NOR LIMIT IN ANY WAY THE cnys 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
WORKMENS CoM%NSATION INSURANCE AND RCW 18.27.
DATE SIGNED
'�W4NPG
7Z*
I A)_ Z 9 _0 3
SE PERMIT
ONE
;603
NUMBER
OB
DDRESS ;4ra��
SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPrOv
RW Wed
Pennit RsqV
Street Use Permit Req'd
EXISTING - PROPOSED
inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION- FT
Underground
I wiring reqiwod 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED 113
I
I
YES 13 NO 13 z
I I
REMARKS
Z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
BY DATE
IRE REVIEWED BY DATE I -.
M
VARIANCE OR CU
SHORELINEORADB#
I INSPECTION
I BOND
1REO'g(
13YE*JQNO
1$ __fOSTED
SEPA REVIEW
SIGN AREA
HEIGHT
'OMPLETE EXEMPT
ALLOWED P ROPOSED
ALLOWED PROPOSED
,
(P
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
�LLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
r
Z
PARKING
LOT AREA
PLANNING REVIEWED, BY -DATE
11201*0 1 PROVIDED,
IEMARKS
:HECKED BY ITYPE OFf7
.WION C0199 ULA; 'ANI
Tj GROU ':P
;PECIALINSPECTION [AREA OCCUPANT
IEQUIRED[3YES 'Z--6ejfi: LOAD
EMARKS
IROGRESS INSPECTIONS PER UBC 16WFINAL INSPECTION REO'D
S ' ,b))1,o ` [_
Description
I FEE
Description
FEE
Plan Check
qlf—
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
PlanChk.Deposh
Fire Inspection
Receipt # _421
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
�2;3 MA
LL
F IN�PECTIO
14-35)
%-Flr-
771-0220
APPLICATION APPROVAL
This applicatIon Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
W. <1
1.nC'-1V- nh-7119S.
RELEASED BY ID E
ATTENTION Off 1 33 &1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 16 :A
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- IV 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
I
. . . . . . . . . . .
ca
io
c-
OT CoLrz"
:,PPR OVED BY PLANNING
-RECEIVIM,
OCT 3 0' 2001
Ob/
cro X JL BUILDING DEPT.*
V%Q>4
d
d
d
4
�g-
d
d
RECORD OF INSPECTIONS
1 4
I
I I I ;p P. 1,
I I p .1 1 21'1
, I I . 1 4
INSPECTOR DATE APPROVED f I
I d
Sege L4�;*r 4 n
d:
SETBACKS,
d 1.
FOUNDATION:
4 L
Footing 4 4.
r
Wall
d
z
I.
Pier/Porch d
C)
'd Retaining Wall
M
d
I d
d
I p I
L d
See
d Slab Insulation
d
ogn
"I 1 1. 1 9 1
4 t
PLUMBING. I ?I P, 1.
p 1,
q.
I )d 1 9 1, .1
JLP I , , X . I , . . 3 1
CUnderground *mesa @*assets
d I
M
1 1 11 '!1 1 d 1104
d p
.'r IS
Rougholn to Shop
01 d .1 , I I I r r 1
d
k
4 1 d I . I
L -4T I
r I o
1p
a
mmercial Final d I
do
I p
9 1 1 1 1 11 p I I r r, r. I I k 0 1 k I I 1. .1. 1 1 4
I el I I p 'r 9 r I I I L -I. I I L 4
I :I I k 1 4 q I 1 4 9 r
:'4 1 r I I 1 .1 1 41 1 1
1 4 1 1 d L 4 r I r I - I
r k 10
H EATI N G d ,
p k I I
9
I d
I L P I r k I
1 '4 1 1 1 r
L k ': '4 d I
I k I
i 9 a a see @*of** does$ go&
Gas Test Moslem Slow 4 d
.p I� 4 1
k
.4 4 1 d z
t I I
'$ ' 4
4 4
See 0 0 9 f 0 @
*Gas Piping
I PL
4 p I I k f k
L pp
k L
L I d
Equipment�
I
d
I k
't W r . I . . I . I I
d d I
k
I d
k I L Commercial Final
d I I I . - r 9
k I
14 L I z d ..4 d .
I . I . 9 . . I . I I I . . 1 9 1 1 ! , r 'r 4
d I k L .4 'L
4 p I k
k EXTERIOR SHEATH 4
ING "L
d L 9
I d,
d
WAILING 4
C
Fn
d r- I I I 'I, I I I
I I I k. I I
ic
C
�L L 'p 'I
I k r r goose 4 1 r r
I I I d I I I I I I j 1, 1 .1 1
I I I d 1, 1 L 1. 11 L L j _r L L L Lyo L I d L I I L;
I . I I I I . I % 1 1 '9 1 1 k
k
FRAMING
k
1 4 11
k I I
4
L, I k ..k I
d
FIRST'FLOOR FRAMING
P I I 1 1 set
I k I 1 4 1
k
r I I d I . I I I . I P' L
NSULATION
k 0 owes @fog* 0 *4
1, r L
p 1 9 1 d
m
qDATE RECOWEO
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NME OF BUSINESS
PAviio P ilATctl P013,fiv 1 136RCj-
MAILING ADDRESS
10 /3 4
CITY ZIP TELEPHONE
am. 0 z S-0
NAME
J= tWMr kjfj& D6116fl 5
ADDRESS
f,O-UZ=t:M 1�77 1510g S77. 54%-)
CITY ZIP TELEPHONE
&) L Yti o 795--l-2
NAME CBL#
103417
DRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DAT. C CKE�D B
01_ .0 Z
001.70 )25 Is
PROPERTY TAX ACCOUNT PARCEL NO.
j %
100619,4001, 007 0.1,--,
Cff NEW RESIDENTIAL 0 PLUM13ING MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
FENCE
REP�IR GRADING, x FT)
CYDS
DEMOLISH TANK OTHER
RETAININGWALL
GARASE 0 FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
9YPE OF USE, BUSINESS OR ACTIVIM IEXPLAIN:
DECIC
NUMBER NUMBERtOF CRITICA4 IZOO'/ W1
Tt I
OF DWELLING
UNIT&
STORIES
DESCRIBE WORK TO BE DONE
Ago A 0-ECK
To FieoN r 0 F 0 as iar
7
HEAT SOURCE GLA23NO % LOT SLOPE %
AjA A tq esr
PLAN CHEQK NO: VESTED DATE
THIS PERMIT AUT14OREMS ONLY THE WORIO PERMIT COVERS WORK TO
b BE DONE ON PkNATE PROPERTY ONi&j STRUCTION ON THE PUBLIC
2 .1019MAIN (CURB . S, SIDEWALKS, DRIVEWIA&GUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160DAYS
IL PERMIT ILIUM I YEAR - PROVIDED WORK IS 4TAIMO WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OFt,93 PERMIT EXPIRES
USE PERMIT
ZONE 47 ("
e -0q 0 7'
NUMBER;003
JOB SUITEIAPT#
ADDRESS 6-11 q �j-a&r
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TESCIR ApPrOved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PeffrAt Required
street use Pernut Roqv
EXISTING - PROPOSED Inspection Required
Sidews* Required
underground
REQUIRED DEDICATION- FT Wring required
METER SIZE LINE Slii�- OF FIXTURES REQUIRED
I I YEps'IV3 No 13
REMARKS
OWNERICONTRACTOR'RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
DATE
FIRE REVIEWED BY DATE
a
z
z
0
M
VARIANCE OR CU
SHORELINEORADB11
INSPECTION
I BOND
REQ'Q1
I
I POSTED.
13YE9�&NO,
1$ -
. =i 1%
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
I
ALLOWE PROPOSED
0 -
_.XP ,
.
C
M
—1
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBAC0 (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
0 r
,;_k,S94
Do,
--:kof &0 6b
M
By L 4DATE
LOT AREA
I PLANNING REVIEWED
I L
RECVD I PROVIDED
.
,_� I I IV)
.
n
CHECKED BY ITYPE OF CONSTRUCTION
SPECIAL INSPECTION
REQUIRED [] YES
REMARKS
INSPECTIONS PER UBC I
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
i . -aAAY
0 _T11
n
OCCUPr
ITIM
GROU
7
OCCUPANT
LOAD 0 Fn
C ca
M C)
FFINALINSPECTIONREG'D
PFEE Description FEE
State Surcharge
City Surcharge
(V 0
;A CANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SLICCESORS
�PLJ
P
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLDIHARIMILEss THe. CITY all
Fire Review
Plan Chk. Deposit
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEEe, ANdAGENITS FROM,'" AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
F61rispection,
Receipt #
00,
WIF
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
Landscape Insp.
Total Amt. Due
UTOA
�_:o
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I 0
Recording Fee
Receipt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 18 CORRECr, 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-
//z C ALL
ALL
APPLICATION APPROVAL
This application Is not a permit until signed by the
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
18.27.
INSPECTIO
F INSPECTIO�
BuOding Official or hitijbisr Deputy: and Fees are paid, and
receipt Is acknowledged In opera provided.
WORKMENS C"P SATION INSURANCE AND RCW
OFFICIALS SIGNATURE DATE
/7 7WVteC;rG a,—
DATE SIGNED
91
fA _;I
(425)
Sr) oa�4_
771-0220
RELEASED BY DYE
ATTENTION
EXT 1333
///eA//`
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
(7 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
0
IT!
j.