20030912.pdfI
DATE RECEIVED /D
=0
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
Eft NAMEINAME OF BUSINESS
MAILING ADDRESSI�j
11 I)Ah
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY - z ZIP __FTELFPHONE
NAME & .
STATE LICENSE NUMBER
PROPERTY ZA&ACr
—,eOUNT PARCEL NO.
xNEW
0 RESIDENTIAL
0 ADDITION
0 COMMERCIAL
0 REMODEL
APARTMENT
0 REPAIR
0 GRADING CYDS
0 DEMOLISH
0 TANK
o GARAGE
0 RETAINING WALL
CARPORT
ROCKr
=R�t_
(TYPE OF USE. QUSIJESS
OR ACTIVITY) EXPLAIN:
02�
W
NUMBER NUMBEROF
OF
DWELLING
o
STORIES
UNITS
-
DE.QP.RIU WORK TO BJE DONE 1� J*A
I
al
0 PLUM13ING / MECH
0 COMPLIANCE OR
CHANGE OF USE
0 SIGN
FENCE
0 ( _x FT)
xOTHEFL h I
0 L V
[PERMIT EXPIRES
USE PERMIT
ZONE NUMBER a b63-06
JOB �7C52Z? SUITE/APT#
ADDRESS
Islas
PLAT NAME/SUBDIVI SION NO.
"a
LID NO.
rT
LID FEE $
TESCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW permit Required 0
Street Use Permh Reqd 0
EXISTING — PROPOSED
Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION- FT
Underground
Wiring required n
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO C3 z
REMARKS z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 5
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE W
m
rZ
Mass
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
BOND
REO'D
E3 YES WNO
POSTED
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE I EXEMPT
EXP
ALLOWED PROPOSED,
ALLOWED PROPOSED
LOT COVERAGE
REQUIRED SETBACKS fFT-)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
-----------
FRONT SIDE REAR
io
FRONT 1 UR SIDE REAR
/0-r z
z
PARKING
RECI PROVIDED
LOT AREA
I PL�NNING REVIEWED BY DATE 5
CHECKEDBY TYfE OF CONSTRUCTION COg" OCCUPANT
.r a.. IA" A11.111, GROUP
CHECKED 'TYP OF
CRITICAL 64= 2
AREAS SPECIAL SPECTOR AREA OCCUPANT
NUMBER REOUI RE YES LOAD
M S
tREMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D
r
:!e NJ VALUATION FEE
01
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
74�
&!Po
PLAN CHECK VESTED DATE PLUMBING If
L� - :�Zzz MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
!Z BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE GnADINGIFILL
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
W
PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION ENG. INSPECTION FEE
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF "NoSeAPS
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND 4u&Pee-Tto a m/
m ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
149 RECEI
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x TOTAL AMOUNT DUE RE2
*j1 _ I I�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZ PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foos are paid. and
07 THEREBY hjO INSP
WASHINGTON RELATING TO
IN VIOLATIOq OF THE LABOR DE F E STATE TION receipt is acknowledged in space provided.
NJ
WORKMEN'fJOMPENSATION S RANC N1 f 1/7. ICIALS SIGNA URE DATE
—A QiljICIALS SIr
SIGNATU WNER OR A ;� /V " I ED _(4 2 5) 'CIAL I ' NATURE
C
4411he I DATEI 44,
fn 0 � 771-022
6z #ELE
B
ATTENTION EXT 13 31 0[h
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE LINT L 771 _n 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF - X ORIGINAL - FILE - YELLOW - INSIECTOR'
. OW 0 - ,
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD ASSESSOR
5/98
I . .
z
0
m
m
C
m
0 C=
m
m z
10-4 : I ' I
z
0 _n
m m
6 Fn
C
0
z
0
4
0
m
d
P
4
I
0
I ot
*�ft
dental
o
d
t
W mmoop, . moon, W, WVWWft W, poppoppop, Wo of 208TH ST SW
W, W,W. " WWWWW W, WWWoo Wo c[c) sn"r o'%,op
W Woo
wr cr am on" �vo
07.0"MW S, W 1/4OSeW 114p ILSRSCO .20WT27 N, R4E. WM, L
M ("Ims/twlop,
(vM LEGBVD in
I a. . 1 0 Sff f/r AWAR / CAP
oppopop, oppppppp� mom, mmo, moon mom, momp, 'pow, mom, amm, WVVW mopoo w pme
opopposlyps. Woop, moo, mom Wwo, Wom, oppow, wappop, mum, somp, amp, ftpppopo� oppow, "Woo, "Wow wpoo, wow, SET CVMCRM XAt MW
room Wool x 5ASPAIN pat$
I QD uc*&&w=r ivor rm
0`11 CR SET Y"X (MRVJ I
uowmxwr nor no
at ar wwumr "w)
4w Duo XC 1/40 emm nor fm I
0 "a fm AWAR dop CA* I
arm" OfAw fLA9"
Idol do %0, X FIC OMMIL MAIL WN
A. FM WWAdIWICASC I
Fw v&"wqr
WTI! DAROW FM SIC"" 114 COMIER
J. Ax 0". &MK P 0 INFIX MW & MOO a WAY (OW cr Caw" (C) CAMILAIM
Iwww MI mveadwa
I*B&t COMM NA& AND nAW*R sm CaVyM&W SCAU some 10 JV 04MM Vw, 4
OF EwFRAmx DowvzwAr TO PARKIPIC CARAC& 1,01 SOUP# (P-0400 ALIRORA "Dwril
PMRR# Mr Or SOU"I KALr Or OF nfRV FLOOR TO PAWWG CARACC IELEV,**40.8 N WASWO
BLK*Z BASIS Or
YjMpr 2row sto sw I FOOM1710 LM
too SLrArTLE MDCWTS IxVq0H taot N M013m ON(C) 01JONCI PER 605W61MA X" VOLTZ P,120L :po fpce Log
mm, popoppo WNW, omm, W, appom, WWpW oppowpo mpoo . wo,ow oppow, Wo"o OWN,, TOTAL LOT 20, M
IOJ o�bf� IMP "c) 10j 94fe) IW-pT 103 g4(c)
oppoppo "Wo
ROAMIME
104forp) r MIS am
W, "y
+ or
T
1w 31 04 jo
ps #4
41stsr c
oft
41
me :Wpp? to
f1w 0
OW 4 tat
A-L I OWL%"*
MOQUE770Y
vur toontoom Cr LOr A LWM W IW SOUTH WV Or KOCK Z
SEAFTLE "N"I'S VWSXW MQ4* ACWRON44 to IW vLAr ngRear
RECOROM IN VOLUVE 0 OF PLAYS, PAGE Ile RfOOROS Cor
VIONO&M C"rr ITASIMCWK
c000wr TIC NOR"I ISO FM viaware I
onuir w Tic c"" or va#mq& STAIr OF WASWCMV,
I" ag am I
SWXCF TO FKLOWV C4SDfWM 01"TRICTIOMPS AM COWN" naft
me 1 1 1 OCT 29 2VA b
tat
to) Arj MMF*
2) At# "09=101
AWNI NA'.
toll
1) fff BUILDING DEPT.
IV
1"3r
,0oL! C
t CL W. eiw w I
L m t! co IN"pip Wo 71c) lump 0
popow, "pow, moom mwL oft,", opopol Wpow,
or
40 �f TV
tE 9`00ow 3 SAO
16 19
WQ-
.---..WWWVW,WW oft"ooppoo mraof�
W omp, owel mo
IT NM'44* IV)
x W78-430 c(c)
PT SW I not
pow M, pool 1. W
moppopmo, Wommoomp, mmomm, mmomm, "Wompoppoo
IF I
r= sw Vo Woop"W"L
so xwn Came
ff f mompo"
mmo, opow, Woo
fCOMM mom, oppopp,
VAC =Wf3owto
OW
saftamf Wn aw TV MCI JM
ILM" rowaftm or Mv "a . ccm)0Aww stmemm
OF fte foldram
3MMIJOWN0 80F AMMIM EVEROAMV COADOMMM
SLOMY STAMM AS TpOI (usnp SAM)
WC 312ftf.10-M PART (f)M) SHE 2 of 4
I 1 1,191, 9 1 o 19 jr 0 0 1
0,
f
kV
. DATE RECEIVE
D/
PERMIT EXPIRES
L
?1/0
F
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER
CONSTRUCT104-PERMIT APPLICATION
JOB
ADDRESS -7c�2o
42
SUITE/APT#
t16
Z lz!Qlz�
�57-S,60
OWtNAMEINAME OF BUSINESS
\ I PTAI le u) M
PLAT NAM E/SU BDIVI SION N07
LOT NO. LID NO.
W
MAILING ADDRESSj
oi) `z)
Qn
LID FEE $
MC
P=ov.d 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW ,u d 0
Street Use Permit Rsq'd C3
ZIP TELEPHONE
.,.EXISTING — PROPOSED
I �
DEDICATION—_,
Inspection Acquired
Sidewalk Requited 0
t" Undarg,ound
III 041RED
glong required 0
NAME
METER SIZE ]J�
LINE S1.jE
�Nq,.,OF FIXTURES
PRV REQUIRED
Y�s NO 0
cc
W
ADDRESS
REMARKS
OWNER/COATR ArTn F"131
FOR �POSIONCONTROLJDRAINAGE
CITY ZIP TELEPHONE
NAME
E'G)NEEPING
PIEVIEWED/DATE
cc
AD(RESS
�0
KI
-01)
FIRE REVIEWED BY
DATE W
CF, I N ZIP TEI.IiPH�O�N
�?It /,Ah
STATE LICENSE NUM915R
1z
EXPIRATION DATE
CHECKED Yr
L49
Q
)tA o=
Uq-.0q
RTR-
PROPE AC I PARICUL NO.
Y �07j,,
I
xNEW
0
RESIDENTIAL
0 PLUMBING / MECH
C] ADDITION
E]
COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
rl REMODEL ,
Lx
APARTMENT
0 SIGN
L
.
—C3 REPAIR
[3
GRADING
CYDS
FENCE
0 X FT)
C3 DEMOLISH
0
TANK
CTrHE
x n _,ah
z
F-
9L
2C
0
t1i
o
a GARAGE
CARPORT
0
RETAIENRING WALL
ROCK Y
C3 AENEWAL
(TYPEOFUSE USIMESS OR ACTIVITY) EXPLAIN:
n -0
NUMBER
OF
STORIES
NUMBER
DWELLING
UNITS
OF
CRITICA
AREAS
NUMBER
DdPC.9[q WORK TO Bf DONE
12 tit- I cck Ile)
CA
ta)
U-n vb
L" VARIANCE OR CU
SHORELINE OR ADBq
INSPECTION
I BOND
j60
IPOSTED
3YREQ-D
ES
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
I
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
POSED SETBACKS (FT.)
ALLOW PROPOSED
ED - --
FRONT SIDE REAR
:NT UR SIDE REAR
[!�
I / T /0
_I 10 t --
PARKING
REO'D I PROVIDED
--j--
LOTAREA
I �-
I �.NNING REVIEWED BY DATE
CHECKED BY j&TYO11F CONSTRUCTION CODE - OCCUPANT
GROUP
SPECIAL INSPECT& AREA OCCUPANT
REQUIRED E] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
PLAN CHECK FEE
HEAT SOURCE % LOT SLOPE %
BUILDING
PLAN CHECK VESTED DATE
PLUMBING
:zzz
MECHANICAL
THIS.PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
L
SEPARATE PERMISSION..._.,.-.
iXTE -�U�&IA46E
rr
�i
PERMIT LIMIT- 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORM�TION.
ENG. INSP " ECTION kE
'APPLICANT, ON BEHALF OF HIS OR HEA SPOLISEiHEIRS, ASSIGNS AND SUCCE RS.
IN INTEREST. AGREES TO INDEMNIFY, DEFEND A NO HOLD HARMLESS THE C11
I!A 40sevIrm
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM AN A
4t"FZCV0N FE
IM ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIR T
K
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
9 DEEMEDTO MODIFY.WAIVEOR FIEDUCE ANX,5EQUIREIVIENTOF AN� CITY ORDINANCE
OR LIMIT IN ANY
0 N HE CITYS ABILITY TO EN
WAY T FQR;]E�NYORD,1NANCE PROVISION.",
I (..
TOTAL AMOUNT DU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIC k�ION; T`H'AT INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF..
THE OWNER. I AGREE TO COMPLY WITH CITY NO STATE LAWS REGULATING CONSTRUC.
L
D PER
TION; AND IN DING THE WORK AUTHORIZE THEREBY, 100 SON WILL BE EMPLOYED
IN VIOLATIOU OF THE LABOR CqDE OF E STATE Q�: WASHINGTON RELATING TO
=01ONSP8CTIC
WORKMEN'S OMPENSATION"RANCE, NDRCW �7.
11V d I
SIGNATU%�6WNER OR A DATE7;jD
Ir d I , Ct/
(425)
-111
ATTENTION EXT 13
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNT qf2l'
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF(771-
-, 14 y
CATE OF OCCWPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
5/98
VALUATION FEE
746
7
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Olficial or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
ICIALS Sl NATURE DATE
N � 0
��Ep ED.1 Y
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR