20030975.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
-7-71Q ZC,(,f'1 S-�,<,(
CITY q, ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
ADDRESS
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E LICENSE NUMBER
EXPIRATION DATE
Al'q
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;ROPERTY TAX ACCOUNT PARCEL NO.
7 n 14
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NEW
RESIDENTIAL
PLUMBIN
ADDITION
COMMERCIAL
Ei COMPIL
CHANGE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS
DEMOLISH
TANK
OTHER
GARAGE
o RETAJNINGWALL FRESP
CARPORT
ROCKERY
FIRE AU
(TYPE OF USE, BUSINESS OR ACTIVITY)
amt—
NUMBER
NUMBWO—F
—
CRITICAL
OF
DWELLING
A
TAREAS
ST RIES
UNITS
UMB
NUMBER
DESCRIBE WORK To BE DONE
If_Vt1.S-1-1A14
CBL #
I
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE I
VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BON13
REO'D POSTED
13YEs 13NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED.
EXP
G / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS ( )
1ANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
OF USE I I
I PARKING LOT AREA PLANNING REVIEWED BY DATE
X FT) REMARKS
RINKLER
M 11
AJi 79 Alea) ;nIAtze f /4, ,L14;,�
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ct, Ith ew
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HEAT SOURCE GLAZING % I I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
— b� J [PERMIYEXPIRES WhI IN
USE PERMIT
ZONE NUMBER !2b6-5-/)q
JOB SUITTEJ/#
ADDRESS 0 at:3�'
LOT NO. LID NO.
PLAT NAME/SUBDIVISION NO. LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pennit Requited
street use Penn" Req
EXISTING - PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT Undetwound
Witing required
METER SIZE LINE SIZ�7. OF FIXTURES PRV REQUIRED
I YES 13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
THIS PERMIT AUTHORIZES 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: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAUL 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING
WORKMEN'S gWPENSATION INSURANCE AND ACW 18.27.
7
SIG;NA�T
DATE SIGNED
�)3
CHECKED BY I TYPE OF
SPECIAL INSPE 0
CTIS 7NA
REQUIRED [] YES
Description
Plan Check
Building P ermit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
CALL
FOR INSPEI
1425) %-Vol
771-OZ
GROUP F,
OCCUPANT
LOAD
2
PER UBC 110111MINAL INSPECTION REO'D
FEE
DescriptIon
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
44 _z
Receipt N
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknovdodged In space provided.
-IVSIGNATU
I ALS S111 DATt
0 t
1 11,4&
AVENTION _t/ EXTA333 ("T
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
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
FIRE REVIEWED BY DATE I
VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BON13
REO'D POSTED
13YEs 13NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED.
EXP
G / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS ( )
1ANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
OF USE I I
I PARKING LOT AREA PLANNING REVIEWED BY DATE
X FT) REMARKS
RINKLER
M 11
AJi 79 Alea) ;nIAtze f /4, ,L14;,�
C
ct, Ith ew
14C'4-1-1nV &AI ww.;�r
HEAT SOURCE GLAZING % I I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
— b� J [PERMIYEXPIRES WhI IN
USE PERMIT
ZONE NUMBER !2b6-5-/)q
JOB SUITTEJ/#
ADDRESS 0 at:3�'
LOT NO. LID NO.
PLAT NAME/SUBDIVISION NO. LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pennit Requited
street use Penn" Req
EXISTING - PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT Undetwound
Witing required
METER SIZE LINE SIZ�7. OF FIXTURES PRV REQUIRED
I YES 13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
THIS PERMIT AUTHORIZES 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: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAUL 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING
WORKMEN'S gWPENSATION INSURANCE AND ACW 18.27.
7
SIG;NA�T
DATE SIGNED
�)3
CHECKED BY I TYPE OF
SPECIAL INSPE 0
CTIS 7NA
REQUIRED [] YES
Description
Plan Check
Building P ermit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
CALL
FOR INSPEI
1425) %-Vol
771-OZ
GROUP F,
OCCUPANT
LOAD
2
PER UBC 110111MINAL INSPECTION REO'D
FEE
DescriptIon
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
44 _z
Receipt N
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknovdodged In space provided.
-IVSIGNATU
I ALS S111 DATt
0 t
1 11,4&
AVENTION _t/ EXTA333 ("T
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
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
w
'DATE RECEIVED PERMIT EXPIRES
-C
Ust PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB
CONSTPUCTION PERMIT APPLICATION ADDRESS -710 oRtl)-M
FOWNER NAMEINAME OF BUSINESS
Ij 1 0 -1- _ j I PLAT NAMEISUBDIVISION NO. LID NO.
MAILING ADDRESS
-7 -7 S+
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CIT f;e4 TELEPHONE
Z'P/�
NAME
. 0t=I ADDRESS
CITY ZIP
NAME ICBL#-,
Nor'-Or_a
ADDRESS
iga3o Awe-
CITY�A , TELEPHONE
12 66�_';6 'k
STATE LICENSE NUMBER
01 17,Al,
1=11 PROPERTY TAX ACCOUNT PARCEL NO.
rl NEW
RESIDENTIAL
rl ADDITION
COMMERCIAL
1:1 REMODEL
0 MULTIFAMILY
REPAIR
GRADING CYOS
0 DEMOLISH
TANK
:-GARAGE
ICARPORT
o RE7AININGWALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
NUMBER
NUMBER OF
OF
STORIES
DWELLING
UNITS
DESCRIBE WORK TO BE DONE
to
D
q_1_.p5
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V
19 PLUMBING / MECH
COMPLIANCE OR
1:1
CHANGE OF USE
0 SIGN
o FENCE
FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW PenrJt Required
Street Use Peffnh RKd
EXISTING - PROPOSED
Inspoction Required
SW&wo* Required 13
REQUIRED DEDICATION- FT
Underground
Wifing required
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
YES13 NO 13
REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE I
REVIEWED BY DATE
FIRE REVIEWED BY
DATE I"
cc
M
A31
VARIANCE OR CU
SHORELINEORADSM
INSPECTION
BOND
REQ'D
I
POSTED
13YEs
13NO
s
SEPA REVIEW
SIGN AREA
. HEIGHT
COMPLETE EXEMPT
ALLOWED
PROPOSED *
ALLOWED
PROPOSED
EXP
,
,
,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
PARKING
REYMP
By DATE
REQ`D PROVIDED
CTi;n
REMARKS
�1_9_
I A 'j,
CHECKED BY ITYPE OF M�� I CODE - UL;UUIPAJ:��
CRITICAL - GROU� I --� _.p
AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMBER REQUIRED L OAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
Y '49-
�UIV 1,1&d
S,0/4//Ct� AJI Ivea.,,
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THiS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRWATE PROPEFIITY ONLX ANY CONSTRUCTION ON THE PUBLIC
M DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
S!!AQATE PERMISSION.
I:
a Q
PERMIT APP Viib, ' 4dokts
N:
PERMIT LJMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAtg 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 $HALL 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 LABOFLCODE OF THE STATE OF WASHINGTON RELATING
WORKMEN'S'900
PENSATI _ SURVANCE AND RCW 18.27.
GIG R E
DATE SIGNED
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
_20
City Surcharge
Plumbing
Mechanical
Grading
Review
Engr. Inspection
Fire Review
Plan Chk-
Fire Inspection
Receipt #
Land scapalnsp.
Total Amt. Due
I
Recordll�!g5m___
Receipt #
C
CALL
FOR INSPECT13
111125)
771-0
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or tJsftwr Deputy; and Fees are paid, and
receipt 13 acknoydodged in space provided.
OFFI ALS SIG TU�R�E DAT
RE1kAhtDBY
IT IS UNLAWFUL TO USE OR OCCU�y A BUILDING OR STRUCTURE UNTIL ---------
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF jDCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING