20030956.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MA-r L C u vin i aq hairy,
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MAILING ADDRESS
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CITY ZIP
TELEPHONE
NAME
ADDRESS
CITY ZIP
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NAME
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ADDRESS
C zip
TELEPHONE
C4 2-S 2—
STATE LICENSE NUMBER EXPJRATION DATE
E ED BY
PROPERTY TAX ACCOUNT PARCEL NO.
NEW O�RESIDENTIAL PLUMBING/MSCH
COMPLIANCE OR
rl ADDITION COMMERCIAL 13 CHANGE OF USE
REMODEL MULTIFAMILY 0 SIGN
GRADING [3 FENCE
REPAIR CYDS X FT)
OTHER
DEMOLISH TANK 0
oGARAGE RETAININGWALL F] F RE SPRINKLER
CARPORT [3 ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVTM EXPLAIN:
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICA
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
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PLM CHECK NO:
VESTED DATE
THIS PERMIT AUTHORIZED ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 180DAYS
CL PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 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 C17YS 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 COMPENSATIO
,WMtIPANCE AND RCW 18.27.
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS 1t2.Pj
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Perm" Req'd
EXISTING - PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT Underground
Wiring required 13
METER SIZE LINE SIZE ] NO. OF FIXTURES PRV REQUIRED
1 YES 13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
obtain Electrical
Swe U.,.�,,tor & 1r,
FIRE REVIEWED BY DATE I
INSPECTION
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LO1-GVARA0E TIMUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR 43
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PARKING LOT AREA I PLANNING REVIEWED,BY DATE
REaD I PROVIDED I
CHECKED BY ITYPE 0 C ON I CQjaE . OCCUPANT
GROUP /\
SPECIAL INSPECTION' JAREA OCCUPANT
REQUIRED LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
Description
FEE
Description
FEE
Plan Check �
I
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
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Total Amt. Due
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FOR IN!
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or histher Deputy: and Fees are paid, and
i acknowledged In space provided.
SIGNATV9E (OWNEWO AGE DATE.SIGNED (425)
6 10 >&Pa
771-0 R
ATTENTION 333
IT IS UNLAWFUL TO USI CUPY A BUILDING OR STRUCTURE qUNT
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
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RECORD
OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
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Wall *.."
.... . .........
R etaining Wall ...........
S lab Insulation ........
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PLUMBING:.
Fl.
round
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'06nifin6rcial Final
HEATING:
Gas''Test ..................
G Piping ...... ..........
its
Equipm, ent.....,-
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C ommercial -Final
EXTERIOR SHEATHING
NAILING
.... ......................
FRAMING ....
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FIRST. FLOOR FRAMING...
INSULATION ............ .......
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAY L _C u vin I n�i kayi/l
MAILING ADDRESS
CITY ZIP TELEPHONE
EAMMAS OqSo2jo 1-4-2_5722L�
NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAME CBL#
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ADDRESS
ZIP TELEPHONE
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STATE LICENSE NUMBER EXP RATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
nCy5n-70CX:)0Q0 SW
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NEW
kRESIDENTLAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
[3 TANK
GARAGE
CARPORT
[3 RETAININGWALL
ROCKERY
ME OF USE. BUSNINIS
OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
STORIES
I DWELLING
UNITS
DESCRIBE WORK TO BE DONE
rN
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB 12- 'P
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
UD FEE S
TEW,P APVDV&d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PenrA Required
Street Use Pennit 1`100
EXISTING - PROPOSED inspection Requim
fildewak Requked
REQUIRED DEDICATION- FT u
Wiring roquLred
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
YES13 NO 13
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE I
mectrIcAl
FIRE I I
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
I I AMID POSTED
on
PLUMBING / MECH
ALLVV PROP6SE61
RONT SIDE REAR
i
COMPLIANCE OR
0
CHANGE OF USE
PARKING
AREA
PLANNING REVIEWED BY
SIGN
REQ`D
I PROVIDED_r
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FENCE
x FT)
REMARKS
0 OTHER
FIRE SPRINKLER
FIRE ALARM
IPROPOSED
3 BACKS (Fr.)
11DE REAR
DATE
CHECKED BY ITYPEMION CODE OCCUPA11TR
GROUP
CRITICAL
AREAS SPECIAL INSPECTION' JAREA OCCUPANT
NUMBER REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
accj it
t.
Rfal rs
te
Description
FEE
Description
FEE
. �V)U�
Plan Check
State Surcharge
a
GLAZING
LOT SLOPE %
Building Permit
City Surcharge
PLAN I�HECK NO:
VESTED DATE
Plumbing
2u
Mechanical
THIS PERMIT AMORMS ONLY THE WORK NOTFAL THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY 0ONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE POWISSION.
Engr. Review
PERMIT APPUCATIOlt 100 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND sucep SORS
Fire Review
Plan Chk. Deposit
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
Fire Inspection'
Receipt III
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapolnsp.
Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY13 ABILITY TO ENFORCE ANY ORDINA14CE PROVISION.,
Reoordi 2fLi:
Receipt #
1032&0
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GNM 18 CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITFI CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This applicaWn 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
FOR INSPECTIO
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In spew provided.
WORKMENS COMPENSATIQWMBUPMCE AND RCW 18.27.
.4.
A-bm�IAA a 01nMAT1 IDA 4T F_
771 -OZ
BY
ATTENTION to _--�333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI1___--`
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN& - 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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