20030967.pdfI
DATE RECEIVED
U�14,02
1
1 PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
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NUMBER ,I - /j
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESSAS.CL/
OWNER NAME/NAME OF BUSINES
A/W 65?1?
04ZI T _reset7y ex 0
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PLAT NAME/SUBDIVISION NO. LID NO.
MAILING ADDRESS
LID FEE
0-y
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pernilt Requifed
CITY ZIP ELEPHONE
Peffnil Rev
EXISTING - PROPOSED Inspection ftclulted
Sidewalk Required
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REQUIRED DEDICATION FT Underground
Wking requi(ed
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NAME
METER SIZE LZ SIZE NO. OF FIXTURES PRV REQUIRED
1 1 YES 13 NO 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME CBL#
VVIL-EY4-j It 67 e- o.
L fAIAL
ENGINEERING REVIEWED BY DATE
ADDRESS
/2y-/* 1-Hv7
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
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VARIANCE 08 cu SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER CHECKED Of REO'D POSTED
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13NO -It
PROPERTY TAI ACOO T PARCEL NO.
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COMPLETE E�� ALLOWED PROPOSED ; ALLOWED PROPOSED
EXP ,
EW 1:RESIDENTIAL PLUMBING/MECH
1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMPLIANCEOR
0 ADDITION COMMERCIAL CHANGE OF USE
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REMODEL MULnFAMILY SIGN
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PARKING 0 FLOT AREA PLANNING REVIEWED BY DATE
REOD I PROVIDE
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MCA
GRADING
REPAIR CYDS X FT)
REMARKS
OTHER
0 DEMOLISH TANK
411
oGARAGE [31 RETAININGWALL F RE SPRINKLER
CARPORT ROCKERY FIRE ALARM
OWE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
11011
CHECKED BY F CONSTRQICTION. con OCCUPANT
ITY
GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
STORIES NUMBER
REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION RECf0
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Description
FEE
Description
FEE
Plan Check
aL
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I
Building Per mit C4 Surcharge
PLAN CHECK Nq: � VESTED DATE
Plumbing
a11:2
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
:X3 DOMAIN (CURBS, SIDEWALKS, DRrVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t:
—
Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WrFHIN 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 WHATEIIER 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 NOR LIMIT IN ANY WAY THE CrIVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATIC r%UAI
IS CORRECT' AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
JdIVEN
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL ThIsappi a an anotapermtun gne y a
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building OffIcIal or hIsItler Deputy: and Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
W MPENSATION INSURANCE AN 18.27.
OF IALS SIGNATURE DATE
DATE SIfD
(425)
141"0"
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771-0220 RB' ____ - ' '
DPE
ATTENTION EXT 1 3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL f a It= "t Af I (-/ f 9�lz 61 /z/
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - APE06OR
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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Date si
ocaprvl.doc.l:tmM:bldg:fo=10/01
I
4 0PATE RECEIVED
CITY OF EDIVIO�IDS .
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMME OF BUSINE
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MAILING ADDRESS
2zS11 0-3
TELEPHONE
CITY ZIP _T
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ADDRESS
USE
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JOB
ADDRESS
PERMITEXPIRES
PERMIT
NUMBER
SUn'F/AFrr#
PLAT NAME/SUBDIVISION NO.
LOFT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCF Approved
AW Perrrdt Required
StrW Use permit Req'd
EXISTING — PROPOSED—
Irrapection Required
SidewsAfloquirod
REQUIRED DEDICATION— FT
Uridergrounid
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES C3 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
TELEPHONE
NAME CBL#
-rW7t1W e. lkez
ENGINEERING REVIEWED BY DATE
ADDRESS
/ ZgL-/ 4' 14*7 Ff S.# Z_
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
C" A% :L�o --? V-
VARIANCE OR Cull SHORELINE OR ADBO INSPECTION BOND
STATE UCE14SE NUMBEII ION DATE qUECKED BY ##REO-0 POSTED
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qJ244
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PROPERTY TA& ACCO PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT.
P
COMPLETE E�� ALLOWqD PROPOSED ALLOW ROPOSED
7
4104��4&7Z5� 1_4-q-5 1
EXP
EW RESIDENTIAL PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS'(FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL muLnFAmiLy SIGN
PARKING LOT A REA PLANNING REVIEWE BY
REOD I PROVIDED P D TE
06
Mel
O.REPAIR [3 GRADING CYDS NCE X Fr)
REMARKS V
DEMOLISH TANK o OTHER
[3GARAGE RETAININGWALL FIRE SPRINKLER
[3 0
CARPORT ROCKERY FIRE ALARM
(I�YPE OF USE. BUSINESS OR ACTrM EXPLAIN:
CHECKED BY TYP F CONSTRUCTION OCCUPANT
GROUP
.NUMBER NUMBER OF CRITICA
OF DWELLING AREAS
I VIA
f
SPECIAL INSPECTION JAREA OCCUPANT
STORIES UNITS NUMBER
- - -
REQUIRED [] YES LOAD
0 ESC RISE WORK TO BE DONE /
—
REMARKS
PROGRESS INSPECTIONS PER UBC 108/1FINAL INSPECTION REGID
4*t,
'0A/ A9-Cr_&4ky x3//
feWaOf 04/ 7*6�P*ere WA-f,
VALUATION
775PA 4 '%;V70 CAWAVINej XA*M
$
Description FEE Description F EE
Plan Check
State Surcharge
HEAT SOURCE GLA23NG % LOT SLOPE %
Building Permit City Surcharqe
PLAN CHECK NOL VESTED DATE
Plumbing
Mechanical
TMB PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTV ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CUMM, SIDIEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSIONL
Engr. Review
POWITAPPILICATION. 180DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTIED WITHIN 180 DAYS
Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPILICANT, 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 MATURE, 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
NOR UMrr IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Recording Fee Receipt #
1'*WMBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATIONAPPROVA
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE-OWNEFL I AGREE TO COMPlY WITH CITY AND STATE LAWS REGULATING CONSTRUC'
CALL This application Is not a permit unW signed by the
TIOWAND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Officiall or hlslhw Deputy: and Fees ma paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
I
FOR INSPECTION rocelp Is acknovAndged In space provided.
"PENSATION INS�YRANCE AN_9.jyV 18.27.
IALS SIGNATURE DATE
8 ING ER FDATE SIGOD
142
771-0220 -R—ELE
Bf
ATTENTION
W 1333
IT IS UNLAWF6L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW - 14SPE&OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBG SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING