20030943.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY z2m zip U ITELEPHONE
7,T,02,0 )-ob 331 ze4.,
NAME
ADDRESS
CITY ZIP ITELEPHONE
CBL #
ADDRESS
VAtrf&A 11&1&Fl 2wb r4p 3T;2-
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
0 RESIDENTIAL
0 PLUMBING / MECH
rl ADDITION
COMMERCIAL
r
COMPLIANCE OR
11 CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
[j REPAIR
GRADING
13 CYDS
o FENCE
( X FT)
I
DEMOLISH
13 TANK
OTHER
GARAGE
I RETAINING WALL
11
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0 NUMBER NUMBER OF VCRITICAL
OF DWELLING AREAS
I I Alk- I
Sj STORIES UNITS NUMBER
!q �DESCRIBE WORK TO BE DONE — I I I - /I Al
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
X
3 DOMAIN (CURDS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERUIT APPUCATION: 180 DAYS
15
LIMIr I YEAR - PROVIDED WORK 15 STARTED WffHIN ISO 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
NOR LIMIT IN ANY WAY THE CITYS 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 LABOB—CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COSM��RANCE AND RCW 16.27.
S�IE (OWN5r4NV DAT� �IGNED
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2
PERMIT EXPIRES
USE PERMIT
ZONE NUMBE��
ADDRESS
JOB 15/ 92
SUITE/APT#
PLAT NAME/SUBDIVISION NO. 17.
V
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Pernift Req'd
EXISTING — PROPOSED
Inspection Required
sidewalk Required
REQUIRED DEDICATION— FT
Un&nround
Wiringr"uIred
METER SIZE LINE SIZ7E NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
SHORELINE OR ADB11
INSPECTION
BOND
RE 'D
1,
00NO
POSTED
I
DYES
$
8EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXCMPT
ALLOWED PROPOSED
AL LOWED PROPOSED
EXP ,
I
,
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
RECID I PROVIDED I
I I
-
REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTION JAREA LOAD
REOUIRED[3YEs Occu7%,
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
I
VALUATION
$ 519tv.
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
IA9112111,
x-r-01
771-0220
APPLICATION APP&ROVAL
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
RUjSED BY D;6E
ATTENTION I I Off 1333 A�A A -
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Z8�W,0,3.
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW'. INSACTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
a
M
DATE RECEIVED
0o [PERMIT EXPIRES U IeZ� b!
USE PERMIT
CITY OF ItbIVIONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB RESS SUITEIAPT#
ADD
01;;�_En NAMEINAME OF BUSINESS _7= LID NO.
7-�P;r PLAT NAME/SUsDrjisiON NO. ILOT NO.
MAILING ADDRESS LID FEE $
/ijh Lqm �q PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE5�APPRI=
RW k.
Sb*d Use P*rmk Wd
CITY ZIP I ITELEPHONE EXISTING — PROPOSED— ImPft-*nR"WMd
S1dawA*ftqu"d
REQUIRED DEDICATION— FT I UndeaouW
;-ob 3312X93 a reqMMM 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
c5
YES 13 NO 13 z
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP ITELEPHONE
NAVE
CBL#
"A
DATE
U
ADDRESS U i6�.
ENGIN R R
Z
FIRE REVIEWED BY DATE 0�
CITY ZIP TELEPHONE M
0
M
U SHOREUNE OR ADBO INSPECTION BOND
VARIANCE OR C
'.'STATE LICENSE NUMBER EXPIRATION DATE ECKED 13Y REQ'D POSTED
113YEs 13NO 6
WA 0 ldt SEPA REVIEW SIGN AREA HEIGHT
r W :F ca :1
ALLOWED PROPOSE P J.
PROPERTY TAX ACCOUNT PARCEL NO, COMPLETE EXEMPT D ALLOWED PRO OSED
M
EXP C
7) M
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (r
NEW 0-,.RESIDENTIAL PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR 0 C
COMPLIANCE OR
0 ADDITION COMIkERCIAL
13 CHANGE OF USE
PARKING PLANNING REVIEWED BY DAT CL
F I E M
REMODEL 0
0 MULTIFAMILY SIGN REQ`D PROVIDE
_[LOT AREA
FENCE z
REFWR X
0 GRADING CYDS _FT) REMARKS
OTHER
01,DEMOLISIi [j TANK
GARAGE
RETAININGWALL
C ORT FIRE SPRINKLER
ARP ROCKERY FIRE ALARM
PPE OF USE.
papt) BY TYPE OFSTRU 1 0 E Occup"T
GROLff, M
'NUMBERL' AL
NUMBER OF CRITIC
OF, DWELLING AREAS SPECVkLINSPEc-noN JAREA occu
LOAD
STORIES UNITS A&INUMBER REQUIRED §
[3 YES C
DESCRIBE WORK TO BE DONE
REMARKS RECVD
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION
?
VALUATION
z
W
Description FEE Description FEE
z
State Surcharge
Plan Check
0
City Surcharge 15
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED4 THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
VAYS, MARQUEES, ETC.) WILL REQUIRE Grading
DOMAIN (CURBS, SIDEWALKS, DRIVE
SEPA4W
.A.P,.W I
t: �p�r. Review
PFRmrrAPs9ccmn
v 7
I .
,D i o =79 100 DAYS
PERMIT LIMM I YEAR - PROVID Ion
SEE BACK OF PINK PERMIT FWM09E INFORMA7141H
Plan Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND Suc�tsoI6
JN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLtSS"THErfty OF. -
HINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire lrispdctlon Receipt #
HATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAGES OF W
FROM',,THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEM11Q TO MODIFY, WAIVE OR RrDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LW!T IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
RecorOigg Fee Receipt #I eo��:2
I HERE13Y 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
This application is not a permit until signed by th
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 CALL Building DMcial or hi0er Deputy: and Fees are W. and
IN VIOLATION OF THE � �SCODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknovAedged In space provided.
WORKMENS CO RANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE
S1Gi;jj#9 (OWN DATE S14NED (4251 lo /,aj 110
771--0220 R SED BY
E
ATTE TION v M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL J
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSACTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION109 PINK -OWNER GOLD -ASSESSOR
GREEN -ACCOUNTING
....04/02 PRESS HARD -YOU ARE MAKING 5 COPIES