20040078.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
C R—Y I h ZIP I TELEPHONE
NAME
ADDRESS
CITY
ZIP TELEPHONE
NAME
ADDRESS
P. 801A
CoM
CITY
ZIP
ELEPHONE
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99;02.42
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STATE LICENSE NUMBER EXPIRATION DATqo"
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0 CYDS 13 ( — X Fr)
DEMOLISH
TANK OTHER
oGARAGE
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[3 RETAINING WhLL FIRE SPRINKLER
ROOKERY FIRE ALARM
MPE OF USE. BUSINESS OR ACM" EX,PLAIN:
4
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OMBER OF
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CRITICAL
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SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved
AW ParrnIt Required
Street Use Parnift Roq'd
EXISTING — PROPOSED
Inspection Requited
Sidewalk Required
REQUIRED DEDICATION— Fr
Underground
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METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
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DATE
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JOYEIS
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is
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HEIGHT
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�"ALLOWED PROPOSED
,
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PROPOSED SETBACKS (Fr.)
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LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 1108/FINAL INSPECTION REO'D
F
Im-ilt— Description Description FEE
().Ljem him., .263-
U State Surcharge
Plan Check
HEAT SOURCE
GLAZING %
ILOTSLOPE%
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PLAN CHECK NO:
VESTED DATE
Plumbing,"
Base Fee
0
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THIS PERMIT AUTHORIZES ONLY THE WORK N&EM THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
:21 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
1: SEPARATE PERMISSION.
Engr. Review
PERL41TAPPUCATION: 160DAYS
AL PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
1j_
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review 4711
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Plan Chk. Deposi'_�
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C17Y OF
— -
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
o
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
—In
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE C17YS 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 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-
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 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 acknowledged In space provided.
WgPKIMN'S qOMPENSATION NOW"CE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
WNER 0 �Aq
DATE SIGNED
(425)
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7-(o - 0,4
771-0220
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EXT 1333
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IT IS KAWFUL TO USE ON OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELI ASPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
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RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEftWE OF BUSINESS
ZIP
NAME
ADDRESS
CITY I ZIP
NAME
V
CBL
11 A f,
_J74�_" 1 PERMIT EXPIFIESIF
USE PERMIT
ZONE
NUMBER
JOB SUITEIAPT#
ADDRESS (06D Be
"A ME
PLAT NAMEISUBDIVISION NO.
P L A T
NO,
LID NO.
rT
LID FEE S
'UC IG
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P U R
TESCP
RW Per" Requirsti
X STI G
E I
XISTING PROPOSED
Street Use Permit Rsq'd
Inspection RsqukW
fildewslir Required
13UI
REQUIRED DEDICATION— FT
tREMAFRKS
Underwound
Mina required 13
M R SI
ETER S17E
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
M I S
OWNER/CONTRACTOR RESPONSIBLE FOR ASION CONTROL/DRAINAGE
OW ICO
ADDRESS
P.D. t. Boy. t00%'(
CITY ZIP TELEPHONE
C
, DM04D5 141ca 114 OZA"k
STATE LICENSE NUMBER
I M_
N N 1 A o
WIT
I,, j I
f IQ
NEW
—
RESIDENTIAL
PLUMBING/MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
-MULTIFAMILY
L-dk
SIGN
GRADING CYDS
o FENCE
X FT)
0 DEMOLISH
TANK
OTHER
0
GRIM E
CARPORT
REIAINING WALL
ROCKERY
FIRE SPRINK ER
FIRE ALARM.�
CTYPE� OF USE, BUSINESS OR ACTIVIM EXPLAIN:
A
NUMBER hiBiR OF CRITICAL
OF WELLING AREAS
STORIES T", 8 NUMBER
'DESCRIBE WORK TO BE DONE
At_%_A"n09__QF Lj2Aj VOL
F ee ALAVUA S%A!�TE7M 106SC
DATE
X
01
FIRE REVIEWED BY D E UJI
cc
C) V6 C),
M
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D
13YEs 13NO
POS D
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
PROPO
ALLOWED BED
M
"XP ,
,
M
—1
LOT COVERAGE
REQUIRED SETBACKS (IT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
0
M
By DATE
,PARKING LOT
AREA PLANNING REVIEWED 0.
VIDED
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Ads,
REMARKS
6i k
.
-
of
..
Irn M
CkbKED BY
13XU OF CONSTRUCTIQ N
OCCUPANT,
GROUP
SPECIAL INSPECTION
OCCUP ANT
JAREA
REQUIRED
LOAD
0)
REMARKS
PROGRESS INSPECTIbf4S PER UBC I 08/FINAL INSOkCTION RE*D
VALUATION,J
$
Description FEE� Description FEE
Plan Check State Surcharge
0
M
UVA7 cleulor-.0 GLAZING % LOT SLOPE %
Building Permit
1)nl�
City Surcharge
PLAN CHECK NO: 0 VESTED DATE
see,
THIS PC THE WORK N n THIS PERMIT COVERS WORK TO '
BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSIOIL
PEwrrAPPucAnoN* �111*6 6xis',-
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plumbing
V
Base Fee
Mechanical
\ �,�
Grading
7
Engr. Review
Engir. Inspection
4
-APP Jr N BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN t:T REjT0 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
11 NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Fire Review
VIA ;( '0>10
Plan Chk. Deposli
Fire Inspection
100
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Be
Receipt #
I HERESY 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 TO
CALL
FOFONSPECTION
APPLICATION APPROVAL
This application Is not a pennh,until signed by the
Building Officlal or his/her DOPLAY: and Fees are paid, w9l
d
rec41 Is acknovAedg0d In space provi ad.
OFFICIALS SIGNATURE DATE
4w) //QV
PENSATION LINSURffE AND RCW 18.27.
1A13
1425)
RE: ER 0 r'AG
DATE SIGNED
771-0220
EW 1333
L D
T-li, I I 7�
ATT90TIOA
I -- I I
IT IS 11WILAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ; I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAI.-FILE YELLOW-- ifiSPECTOR I 1�
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK-OMER GOLD-ASSEtSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES