20030958.pdft
DATE RECEIVEY,,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
ACA / _A0 sc, '. V Ac,.e I--<t.
MAILINGADDRESS
CITY ZIP TELEPHONE
Ur ... .
NAME
CITY ZIP TELEPHONE
NAME
/z5w lzrnp
ADDRESS
3&2X
CITY ZIP TELEPHONE
�� tY14- W/1-) -,4 �: ?,.-,? -
STATE LJCENSE NUMBER EXPIRATION DATE I
TAX
NEW
11 RESIDENTIAL
ADDITION
><COMMERCIAL
REMODEL
0 MULTIFAMILY
REPAIR
DEMOLISH
TANK
oGARAGE
RETAINING WALL
CARPORT
ROCKERY
"E OF USE, BUSIN ACTIVITY) EXPLAIN:
NUMBER
OF
NUMBER OF
DW 'ELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
13 PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
M-WilCE
.7r X jj!�_ FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES 1!;21
ld�+—
USE PERMIT
ZONE
6q
NUMBERr
42b&3
JOB '2�,g SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
—1
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW- ", : P" = .
Street Use Permit Req'd
EXISTING — PROPOSED
Inspection Required
Sidewat1k Required
REQUIRED DEDICATION— Fr
Underground
wiring required CI
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES13 NO 13 0z
REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
Y . . - . _ - - - 1_-� - , I - j ; .- .. - �_ /_
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHOJIELINE OR ADB# I INSPECTION
BOND
00h F--A-A L AEO'D
POSTED
Is
jMs ONO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED ,.ffOPOS
,
I
I
EXP P<
<� I
�j
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REA
PARKING
LOT AREA
j.CL#AI09 REVIEWED BY
DATE
REQ`0 j PROVIDED
_
---*% I /--.)
F_
9
NOT
C TYPAOE CONSTRUCTION CO5 OCCUPANT
? GROUP
CRITICA 14 Al
AREAS SPECIAL INSPE90hON JAREA OCCUPANT
NUMBE REQUIRED ETYES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'O
L41"'& - Z. 'e... 3 1
VALUATION
Ale owvh"4�
$
V
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
�ECK NO- VESTED DATE
zya-L
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISO DAYS
06 PERMIT LIMIT: 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 SUCCESORS
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
Fire Inspection
Receipt #
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
Landscapelnsp.
Total Amt. Due
0
.1 NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
_7T_
Recording Fee
Receipt #
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 M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or histher Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATI? 18.27.
Njh1.SURANCE AN2..PM
0 -
SIGNATURE (CKER KAGEP$"'), _,,O' DATE SIGNED
(42
OFFICIALS SIGNATURE DATE
Vn 9
771 -0220
. n
"MENTION
EASED BY
rOR
EXT 1333
IT IS UNLAWFUL TO Ud OCCUPY A BUILDING OR STRUCTURE UNTIL
_ i
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - I�VpEcT�R
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
0
M
171
M
0 C
M M
4
0
M M
(j)
Fn
C V)
0
X
z
0
0
M
f
I I "
k
z
0
1
0
m
:i:9
m
c
MO
0
--lo
0
--I
m rn
M z
10-1
c
E::
0 -n
n
mm
a v;
0 r-
0 M
C
M 0
Z
z
cn
z
9
0
m
I
"Al
PERMIT EXPIRES
�,,QDRTE RECEIVELT
CITY OF EDMONDS
USE PERMIT
ZONE t6 , 6 q
NUMBER 6� 6
CONSTRUCTION PERMIT APPLICATION
JOB SUff/APT#
ADDRESS7
4�il�p J��
OWNER NAME/NAME OF BUSINESS
/40/1 / Rosin, r 3e A q
PLAT NAME/SUBDIVISION NO. j
LOT NO.
LID NO.
LID FEE $
MAILINGIADDRESS I
EXISTING - PROPOSED
REQUIRED DEDICATION- FT I
1
TESCF Approved 13
RW Perrrht Required
Street Use Permit ReqV
Inspection Required
Sidewalk Required
UnGffy�
vvimg requ 13
P cc
CITY ZIP
S141A ri el -IT .1
5 1
TELEPHONE
�111,K
NAME
METER SIZE
LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
YEsI3 NO 13
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
ITELEPHONE
224 el,96
NAME I JCB
B , ZISA 62axip _)Zwv
ela
ENGINEERING REVIEWED BY OAT
A?
ADDRESS
-39074
FIRE REVIEWED BY DATE
us
CITY ZIP
TELEPHONE
ug:
VARIANCE OR CU
EORAqB# INSPECTION
PIN., AEO'D
;Ks 13NO
POSTED
1$ BOND
STATE LICENSE NUMBER EXPIRATION DAI E
j t_'j< `9911 Q d r
CFMCKED B
SEPA REVIEW
COMPLETE EXEMPT
EXP I .;;<
SIGN AREA
ALLOWED. - PROPOSED
- -now
11
, HEIGHT
ALLOWED Nj"OPOSED
PROPERTY T�AX�AVfrn PARCEL N9.
r
W:z e
NEW RESIDENTIAL PLUMBING/MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSEO SETBACKS (Fr.)
FRONT L/RSIDE REAR
PARKING LOT AREA I.CLA"N9 REVIEWED BY DATE
REQ'D I PROVIDED I
14e
[:]'REMODEL 0 MULTIFAMILY SIGN
CE I
REPAIR I" CYDS G X F-I)
.me*
RKS
D�M'OILISH 0 TANK o OTHER,
ri GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT 0 ROCKERY FIRE ALARM
(TYPE OF USE, BUBLINTMBRACTIV
VrM EXPLAIN:
-oo-
WMPW
TYP OF CONSTRUCTION
C�p
OCCUPANT
GROUO
NUMBER
OF
STORIES
NUMBER OF
DWELLING ZkIA
UNITS
CRITICAL
AREAS
NUMBE
SPECIAL INSPEION JAREA
REQUIRED YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE'DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTI ON REG-D
41in rle2"P%el in.4 .!rtlz mo e-
e- Coda
NtmiVir
A
VALUATION"'
LIVIr
pbs CrIption
FEE
Description
FEE
fIan-0.4eck
lCitySurchar&i-
State Surcharge
HEAT SOURCE
GLAZING %-
'jL,Orr SLOPE 9A
Bu ilding Permit
PLAN CHECK NQ; VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
t:
15
BE DOKE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEE% ETC.) WILL IIIEQUIRE
SEPARATE PERMISSION.
PERMITAPPILICATION: ISODAYS
Engr. Review
Engr. Inspection
IL
PERMIT ILIMM I YEAR - PROVIDED WORWIS STARTED WITHIN 180 DAYS
SEE BACr OF PINK PERMIT FOR MORE INFORMATION
.APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire,,Review
Plan Chk. Deposit
IN INTEREST, AGREES TO IN DEMNIFY, DEFEND AND HOLD HARMLESS THE CrY OF
'
EOMONDS, WASHINGTON,, LIS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGMF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
0
Landscapeinsp.
Total Amt. Due
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
21
NOR LIMIT IN ANY WAY THE Crff.S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
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 CrrY 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
APPLICATION APPROVAL
This application Is not a permit until signed by the
CALL Building Official or hisihor Deputy: and Foes are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMENS COMPENSAT90ANSURANCE AN?
I .06W 18 27.
OFFICIALS SIGNATURE DATE
1,A95) � loqh)�,s
R 96AGglillf'Sit _..00"
DATE SIGNED
771-0220 RnEASED BY ATE
ATTENTION
IT IS UNLAWFUL TO U OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS . BEEN MADE AND APPROVAL OR A CERTIFI-"'
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE
M 1333
—4p a LhL
U, ORIGINAL -FILE YELLOW- IN4PECT4R
PINK -OWNER GOLD -ASSESSOR
MAKING 5 COPIES GREEN ACCOUNTING