20030946.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATIO14
OV�NgR NAME/NAME OF BUSINESS
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LPERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS 1q702 26)14 pl
SUITEJAPT#
PLAT NAMEISUBDIVISION NO.
LOT NO.
ID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ION '-ad
RW Pa'ZIR'.k.
S.1 Use Permit FIWd
EXISTING — PROPOSED
Inspection Requ;md
Sidewalk Required
0.
REQUIRED DEDICATION— FT
UndorWound
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
YES C3 NO (3 z
REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE LICENSE NUMBER
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PROPERTY TAX6COUNETIARCEL NO- 5-00
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Or
ADDITION
COMPLIANCE OR
0 COMMERCIAL CHANGE OF USE
REMODEL
MULTIFAMILY SIGN
REPAIR
FENCE
GRADING CYDS t —_ X FT)
0 DEMOLISH
OTHER
TANK
GARAGE
CARPORT
[3 RETAININGWALL FIRS SPRINKLER
ROCKERY FIRE ALARM
OWE OF USE. BUSINES
ITY) EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
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AREAS
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STORIES
NUMBER
DESCRIBE WORK TO BE DONE 17..kt � _ _ ,; � /N--4.n jk V
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FCA—N CIIIIECK NO: VESTED DATE
THIS PERMIT AUTHORIMS ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONILf. ANV CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 160DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STAFITED 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
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREUY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGE14T OF
IHE 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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGN GE 0 MATE S N ED
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FIRE REVIEWED BY
DATE W
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VARIANCEOR CU INSPECTION BOND
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nsion
as Xks". TPRMSED SMACKS (FT)
LOT FRONT LJ E REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
RECYD I PROVIDED I I
CHECKED By I TYPE Pj Ifl_
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rAREA CUPANT
L—INSPECTION Cc
SPECIA LOAD
REQUIRED n YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION FIE-Vu
$
Description FEE
Description
FEE
Plan Check
State Surcharge
Je
Building Permit
City Surcharge
Plumbing
ftu j
Mechanical
]
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
tRecelpt
#
Recording Fee 1p
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building omcial or histher Deputy: and Fees are paid, and
R INSPECTION receipt Is acknowledged in space provided.
(425) FIC ALS SIGNATyREr% DqE
— lAilsh
771-02 LEASED BY DATW
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33
ATTEFiTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNT
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
RECORD OF INSPECTIONS
L
I
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OVM�N5" OF BUSINESS
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MAILING ADDRESV
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NAME
ADDRESS
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STATE LICENSE NUMBER EXPIPAPOP DATE E ED BY
IA
PROPERTY TAXecrouqARCEL
NEW ;Ii—FIESIDENTIAL PLUMBING/MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
Il REMODEL 0 MULTIFAMILY 0 SIGN
E
GRADING F NCE X FI)
REPAIR CYDS
[T DEMOLISH TANK 0 OTHER
c30ARAGE RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY FIRE ALARM
"E OF USE, BUSINES CTIVITY) EXPLAIN:
NUMBER UMBER OF CRITICAL
N
OF DWELLING AREAS
STORIES NITS NUMBER
DESCRIBE WORK TO BE DONE
me
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I OOL&+-e) %=Jh b.4y-ekwtt V
ell IL.�
H= GLAZING LOT SLOPE %
PLAN CAECK NO: VESTED DATE
THIS PERMIT JWTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LJC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 188DAYS
ILI PERMIT LIUM 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 ISSUIkNCE 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 HE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEffS COMPENSATION INSURANCE AND RCYV 18.27.
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB UrrF-/An#
ADDRESS 1q702_ 236 X4 jal s
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Appnrlod
AW Parritit Required
Street Use Permit RWd
EXISTING — PROPOSED
Inspecdon Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
I Wmg required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
F REQUIRED
1
I
13
1 YEPsRIV3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
re,g-ulredonfuel-burningsippllincesis
unbeated spacm UMC 815-1.7
TN_GINE Rii
R 5!22088 of whether the.w8ter 809M
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FIRE RE�Vl open or cmeu, expolunwill Mal RATIF %P
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VARIANCEI)UW %;Q9fkO8WM*ft0-_aftVE190Tf0N I HD
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SEPA REVIEW
SIGN AREA
HEIGHT.
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
BY
PARKING LOT AREA
RECI'D I PROVIDED I
PLANNING REVIEWED DATE
06
or
CHECKED BY ITYP I E qMt
SPECIAL INSPECTION JAREA
INSPECTIONS PER UBC 1106/FINAL
VALUATION
$1.01780 -..* L
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
NO
1.0
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapainsp. Total Amt. Due
Recording Fee Receipt # UOL
APPLICATION APPROVAL
CALL This application Is not a permit until signed by the
f6X Building Official or his/her Deputy: and Fees are paid, and
R INSPECTION receipt Is acknowledged In space provided.
F JkL6 SIGNATNR
K;L
BIG (OWN DATE 8 ED
40NA 1%4-
3 771 -01 LEASED BY
A rMNTION
"ItEWTION 33
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE LINT ;;p
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE ' RTIFI- 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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