20031002.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OI�T�NAMEINAME OF BUSINESS
,_ ) ? �'_ CP'UV1
MAILING ADDRESS
4-&uLj 2,01 �H— YV-- Sk-'
CITY Z,40P TELEPHONE
& 14190 1 �j?j-.-77 -1-72-3
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME CB& �7
ADDRESS
Po-\2--,rj4 (�o?-3
CITY ZIP TELEPHONE
L'4 To vj"�) ) W -x ge"Id 01
STATE LICENSE NUMBER EXPIRATION DATE
AI
I'L-S:� o
PROPERTY TAX ACCOUNT PARCEL NO.
000 2,02_booc)0-:H:)0
NEW RESIDENTIAL UM
;< PCDMPBL11NACNCE�R
VffD-ITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
L-----------------------
REPAIR GP-41111 FENCE
460CYDS ( _ X_FT)
- 0 OTHER
DEMOLISH TANK
GARAGE RETAININGWALL [3 FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINI kSS OR ACTIVTM EXPLAJN:
L4- C.-4z-- — (0)
NUMBER NUMBER OF CRITICAL
OF DWELLING ARE
STORIES UNITS NUN
DESCRIBE WORK TO BE DONE
uwt V.N 0
qLk L 0 k ri cl r C) s
LOT SLOPF-%
lzu
PLAN CHECK NO: lwp Z/P5
— 2(j -
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, IETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 CITY'S 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S E SATION INSURANCE AND RCW 18.27.
81 RE NE R AG'ENT) DATE SIGNED
—0
1/0 '�Ai
PERMIT EXPIRES
m
7SE PERMIT
ZONE NUMBER,,$&2:�?
-Ijj;�4
JOB
ADDRESS
SUITEIAPT#
QL�Ll
PLAT NAMEISUBDIVISION NO.
-7
NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
n W k_
al .. P:q
street so 4rMltRq
EXISTING — PROPOSED
inspection Required
Sidewalk Required
DEDICATION FT
under
REQUIRED
I widn" 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES113 NO 13
REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
t)A-% AA
11
FIRE REVIEWED BY DATE 11"
VARIANCE OR CU
SHORELINE OR ADIBN
I INSPECTION
BOND
POSTED
REQ'D ,
is
113yr=s,;8�o
—
BEIRA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
PROPOSE,
ALLOWED D
EXP Xmas
/ ,
2-5 / Ll
LOT COVERAGE '
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
IVA
/V,11�'.4q 1/0//a I%- z
PARKING
1
LOT AREA
PLANNING REVIEWED BY (J DAtE 9L
1
RECID I PROVIDED
--7
e_
CHECKED BY iTyMAUCTION CODE OCCUPANT
GROUP
JAREA
SPECIAL INSPECTION OCCUPANT
REQUIRED LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC IGOIFINAL INSPECTION REaD
I ILI I &-! Z
L
Description
FEE
t'on
Description
FEE
Plan Check
;�l 65
c rge
State Surcharge
hag
Building Permit
�Z-7
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
—
Fire Inspection Receipt # -1'2'
1 1 dco-s—.446"
Landscapoinsp. Total Amt. Due 1. 1W
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy; and Fees are paid, and
FOR INSPECTION receipt is acknowledged Inspaco provided.
OFFICIALS SIGNATURE DATE
1A =% I //
t-125) tj�_ 4� 0 &a_
771-0220 ASED 8 f - PATE
ATTENTION t:A 1 1_4 a A hllj�m
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 0 j
= I Wile QA41NSPExf)
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- , � I W- 'N-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
11
0
M
M
M
-0
40
0 C:
I x
M M
0
C
Z
(A
0 -n
3"! 1
Irn M
9 [0)
0 Fn
H
CO)
z
0
4
0
IT!
LO*r Of 514-OG-My"ov-4 c7zKw
arry aw UP.MoNtws RECEIVED
NOV 12 2003
DEVELOPMEN SERVICES CTR
Goo C41TY OF MONDS
Moo- +
0 7
7710A�7UM P 0 1 Mlr 71
CIT
CL
>
to ccl
LLJ
V
2 06 CL
'A
-ml
ZZ,
I P5
r 9; i�;
J
z
0
1
0
m
=i:q
654
am
c
ma
0
40
3: M
M Z
co
0 -n
n
M m
a
0
0 M
C CD
c w
M 0
Z
z
co
z
9
0
m
2.
RE-DWECTED OUTSTAMING ISSUES - MAPT FINAL FROJECr APPROVAL.
S*
uunin vjJA=L*Wbk4*Ml0/01
I
0
RECEIVED
a
CITY OF ED"ONIDS
CONSTRUCTION PERMIT APPLICATION
OW E OF BUSINESS
3WNAMEMAM
J C
MAILING ADDRESS
Ap LA- 2,o 1 )06-
CITY 41P TELEPHONE 17Z3
y, r-
ril 0-yi t),> 6,
NAME
ADDRESS
CITY zip
TELEPHONE
NAME
C'�e-n
I
ADDRESS
Pic, 3
CITY ZIP
L.,4 vo"w0i o� qpq
TELEPHONE
q)�- - ? -) �- - � ? 1�
ST,ATE LICENSE NUMBER
EXPIRATION DATE
CL-S ± -* --f: * 7 g I R �-
( -z r-
PROPERTY TAX ACCOUNT PARCEL NO.
601� 2,02—00000-+c)0
[:3 NEW 1K RESIDENTIAL
PLUMBIN MECH
COMMERCIAL
COMPLIANCE5
0 -CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
0 REPAIR 0 ING CYDS 0 FENCE X FT)
[3 DEMOLISH TANK
0 OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSII�IEPS OR ACTIVITY) EXPLAIN:
hkil
�NUMBER
UMI
0
NUMBER OF
DWELLING
CRITICAL
AREAS PP4
W7
'OF
, TOR
STORIES
UNITS
NUMBER
-DESCRIBE WORK TO BE DONE
A-b v) `�-o unx t,,AA i u K)
. n 1 1��M &H I Lj-
wood
---� -t,
FalrX-IL]
-2,
®r-"
1 PERMIT EXPIRES
USE
ZONE
PERMIT
NUMBERI"-
JOB
ADDRESS
SUITE/APT#
5
P.L...L
PLAT NAME/SUBDIVSION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TL5 r Approm
RW rP9nnIt 110qulf6d
Street Use Peffnil Req'd
EXISTING - PROPOSED
Inspection PAQUIned
Sidewa* Required
REQUIRED DEDICATION Fr
UndwWotind
woo g I
METER SIZE
LINE SIZ E
NO. OF FIXTURES
PAV REQUIRED
I
YES 13 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
o . I k -W -- I , III %It A 11W--�i D % f I I A I ( Pe cvj.,;A
WMINN "I
INGINEERING REVIEWEOBY DATE
N
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION I
BOND
I
REqD .
POSTED
C3Y ES11MO
-
1$
$EPA REVIEW
SIGN AREA
-
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED
PROPOSED
/
"XP
I. P-tv .
,
/,t
,
svocws
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
m�.4,q I/eyq v
0orl
PARKING
LOT ARE�
PLANNING REVIEWED BY %Z DAtE
CL
REO'D
PROVIDED
I?
q3&
SK ZV� *7 e 11 1614
CHECKED BY
SPECIAL INSPECTION JAREA - !1.�
REQUIRED[jYES
REMARKS
PROGRESS INSPECTIONS PER UBC I
Description
Plan Check
Building Permit
Plumbing
1)2 -211,2-1 Irttv ...echanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COMERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION1,00"Iff PUBUC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.)'WIi&REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN N 100 DAYS Engr. Inspeco5h,
SEE BACIC OF.PINK PERMIT FOR MORE INFORMATIO
OCCUPANT
GROUP
, i
3CCUPAWT
LOAD
INSPECTION REG'D -
9
fl FEE Description FEE
State Surcharge
City Surcharge_
FEE
c
C
LOT
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire HevieW
Man LAK. It
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 #
2 31
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. MSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODWY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECr 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.
CALL
This application Is not a Perm it until signed by the
Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION QF-;�PE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'S 5fWyATIONINSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
ALdEfM
DATE SIGNED
IA05)URE
qnco
_LR 3
MENTION
771-0220
EXT 1333
L ABED BY f jbATE
"/o,n A .1, A j
im
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTUREUNTIL I it 1 8�v V1. '7 L - 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- RIGINAL-FILE YE1100/11SISPEXTOR,
PINK -OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 IV
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
z
0
4
0
IT!
M
C
M
0
10
0 C
0 -n
N
Irn M
0
0 Fn
C
In C).
z
W
z
0
I
0
M