20030994.pdf13
I
A
DATE RECEIVED
L llh-yz� I
IT EXPIRES se"a
USE PERMIT
CITY OF EDMONDS ZON 994--
NUMBER
JOB SUITE/APT#
PERMIT APPLICATION
ADDRESS .19 111� I
AW/// 9q
OWNER NAME/NAME OF BUSINESS
,)e ^Nve PLAT NAMEISUBDIVISION NO. LID NO.
" HA #A 1 4 V DQNf*L IfAe
L C#
MAILING ADDRESS LID FEE $
TESCP ApPrOVO4
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required
96;;- Hwy q
street use Permit Req"
CITY ZIP,,,,,,ITELrPHONE EXISTING PROPOSED InspectRm Required
Sidewalk Required
72 REQUIRED DEDICATION- FT UnderGround
`17,3�- 7 72 tq Wiring required 13
NAME METER SIZE LINE SIZE 7, OF FIXTURES PRV REQUIRED
YES[3 NO C3
c:
ADDRESS REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME CBL#
Ap
5 S'/fAt_S 16116. I-hN ENGINEERING REVIEWED BY DATE
C AIZRESS
FIRE REVIEWED BY DATE
z
C1 ELEPHONE
U ki
cc
IE
0
rz CA 7t,
0
I
VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
STATE XI ON DATE CHECKE9, BY REO'D POSTED
"CLILWO I 113YES d"NOL
4t"003-97 PW
MN
Itc SEPA REVIEW SIGN AREA HEIGHT
%
PROPERTY TAX AC rrTT V COMPLETE EXEMPT ALLOWED PROPOSf'D ALLOWED PROPOSED
COUNT PARCEL NO. 9
P'k PAU - I i
Wo PUtf1W A
ev
, ,
ve
ow EXP Lab "+I W* - 10. 1'
M
C:
M
- ,
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
NEW 0 RESIDENTIAL PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
ADDITION OMMERCIAL /Vif,
0
;91C CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ`D PROVIDED
M
I
GRADING o FENCE +1 4- 1
REPAIR CYDS X FT) REMARKS
z
OTHER
DEMOLISH TANK
GARAGE RErAJNINGWALL FIRE SPRINKLER
13ROCKERY
CARPORT FIRE ALARM
0
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
R TYPE OF�WNSTRUCTIIDN co OCCUPANT
GROUP
Z77-
I ITIM
NUMB ER NUMBER OF CRITICAL.
OF DWELLING AREAS SPECIALINSP CTION OCCUPANT
STORIES N., ti NUMBER REQUIRED YES LOAD
0
DESCRIBE WORK TO BE DONE a
AIS Ceg REMARKS
rnUGRESS INSPECTIONS PER UBC 100/FINAL INSPECTION REG-0
0
VALUATION
$/
Description FEE Description FEE
0)
z
Plan Check
1
State Surcharge
HEAT SOURC= GLAZING % LOT SLOPE % Buildl I ng Permit City Surcharge
1502 1
M
VESTED DATE 414 Ab)yd
PLAN CHECV Plumbing LIM
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
a Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Iz- SEPARATE PERMISSION.
2 Engr. Review
I PERMIT APPLICATION: 180DAYS
a. 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 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 FO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSRANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE Landscapeinsp. Total Amt. Due 16—
OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." -7-7
Recording Receipt N
1 :22
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLIC ATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREEY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowiedged In space provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
DAT
IALS SIGIATURE
SIGNATURE (OWNP-0TIrGEN_7')�I DATE SIGNED (425)
V0111 771-0220
L ASED BY DAVTE
WRATIOff— off 113
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR�GINAL - FILE - YELLOW - &SPEC R&
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P NK - OWNER - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKI G 5 CO;fffi� GREEN - ACCOUNTING
M!
'0,'DATE RECEI��;/ r
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAmE/NAME OF BUSINESS
C _HNIV HA111V t9VQVvd Df-ty AL CAf
MAILING ADDRESS
HWY 19
CITY ZIP ELEPHONE
CIA 1
I �- rlw_fu )A C , - "& f)7- 'IT I-qZ57- 772- 431-q
NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAMEP09VI-& S*ka^FVXj)
P V3
Crl'rukl ELEPHONE yg- q
- '% f=: a - -6, u �7_f!
JA"im --;!4 - S7034"'I 7.
STATE LICENSE'NUMBER A .FXqIM0N DATE I CHECKEr
.A BY
�9-
1:3 NEW
RESIDENTIAL
1:1 ADDITION
O.C.OMMERCIAL
1:1 REMODEL
0 MULTIFAMILY
REPAIR
GRADING CYDS
[3 DEMOLISH
TANK
oGARAGE
RETAININGWALL
CARPORT
ROCKERY
UWE OF USE, BUSINE88 OR ACTIVITY) EXPLAIN:
L /V rh
L_.
.NUMBER
OF
NUMBER OF
DWELLING
STORI
UNITS
DESCRIBE WORK TO BE DONE
PLLIMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
ciFENCE X
( — FT)
rl OTHER
FIRE SPRINKLER
FIRE ALARM
1'1%�.'j PERMITEXPIRES .9 1 1 -
�5 %.. YL
USE<p PERMIT
ZON
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. Loe LID NO.
LID FEE $
TFSW APPfOvdd
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW POnrAt Required
Street Use Peffnit ROO
EXISTING - PROPOSED Inspection Raquired
Sldsws* Required
REQUIRED DEDICATION- FT UnddrgmM
wiring required 13
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
1 7. YES C1 NO E3 z
REMARKS I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
I I
REVIEWED BY I DATE
FIRE REVIEWED BY DATE W
cc
MA—RIANCE OR CU
SHORELINEORADB# I
INSPECTION
BOND
AVPW
REO'D
113YES &NO
POSTED
I $
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PRO10JR0,
ALLOWED PROPOSED
,
Itto bit - I
,
A
"=� ,
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
i I
NI.,
tic,
IV6, 2
PARKING
I
LOT AREA
PLANNING REVIEWED BY DATE I
916
I
REO'D I PROVIDED
IL- .— .- -
CHECKED BY TYPE OF QPNSTRUCTION CODE OCCUPANT
GROUP
CRITICAL C/7
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER Alt", REQUIRED [:] YES LOAD
,/Cd'IREMARKS
PROGRESS INSPECIIIII1141*010MIS/ Inu
21 L
REG-0
000 All
Description
FEE
Description
FEE
Plan Check
Md
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE
Building Permit
City Surcharge
PLAN CHECr VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORMS ONLY DIE WORK NOTED. THIS PERMIT COVERS WORK TO
b BE DOME ON PRr4ATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
2
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
9
Engr. Review
PERMIT APPLICATION16 180 DAYS
ERMIT LIMM I VIM - PROVIDED WORK Is s=TD WITIN 180 DAYS
E�ngr. Inspef4ion.
SEE BACK OF PINK PERMIT FOR K0 TION
-AppucAffr, ON BEHALF OF HIS 08 HER SPOUSE, H6FA9_. ASSIGNS AND SUCCESO
TO INDEMNIFY, DEFEND AND . MOLD HAnml.Eas THE
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES 'CITY'83F.
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM 'ANY AND
Rre 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
Landscape Insp.
Total Amt Due 116
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
f
ADEEMED
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENrORCE ANY ORDINANCE PROVISION."
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 OWNEW I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Tills applicafic n 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 LABOWCODE OF THE STATE OF WASHINGTON RELATING TO
Building Otkial or his/her Deputy: and roes are paid, and
FOR INSPECTION receipt 15 acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
------- r..
AALS SIGNATURE DATE
FF S S
SIGNATURE (OWN GENT) DATE SIGNED
11 G
lAor.1
"mw%ri
-
�/
/Z -03
771-0220
RLASED BY DATE/
ArWTIOW—
off 1! �3
" �(
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL _��
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
C_ n i ow - 6PEaR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5CO P�� 13REEN - ACCOUNTING
----------- --------- _.... ........
M
C
M
40
0 C
:0 x
IT! M
z
0
n
M M
a 7W
C CA
r, 0
ma
z
0
4
0
11711
4