20040168.pdf4
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
,ER NAMEINAME OF BUSINESS
NAME
ADDRESS
CITY
NAME
ADDRESS
j
ZIP ITELEPHONE
ZIP
STATE LICENSE NUMBER
'00, P. 46 a —4 -A A AV --tP .0
NEW
[3 RESIDENTIAL
[3ADDITION
COMMERCIAL
REMODEL
REPAIR
_XMULTIFfILY
GRADING CYDS
0 DEMOLISH
0 TANK
oGARAGE
CARPORT
o RETAJNING WALL
ROCKERY
I(TYPE OF USE. BUSINESS OR ACTWM EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
�? I UNITS
STORIES CAV
DESCRIBE WORK TO BE DONE
S AE
ZONE Paz
JOB
ADDRESS
PERMIT EXPIRES
PERMIT
NUMBER 401941,1,
SUffF:/A"#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW P@m0t Required
Street We permit RWd
EXISTING - PROPOSED
Inapecilon Required
Sidewalk Required
REQUIRED DEDICATION— FT
UnderWound
wiling required 13
METER SIZE
LINE SIZE _FNO.
OF
PR 0
SFIRES
YES KEQUIRED
NO 13 ;1
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL N
ENGINEERING REVIEWED
BY DATE
FIRE REVIEWED BY
DATE
M
:PHONE
VARIANCE OR CU
I
SHORELINE OR ADBN,
INSPECTION
REQ'D
BOND
POSTED
is
RATION DATE
CHWKED BY
/9�!f?
13YEs ONO
BEIRA REVIEW
COMPLETE EXEMPT
SIGN AREA,-
ALLOWED PROPOS Ell
HEIGHT
PROPOSED
,
.,ALLOWED
EXP
PLUMBING MECH
I
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FTY
FRONT SIDE HEAR
PROPOSED SETBACKS (FT.)
FRONT LIRSIDE REAR
COMPLIANCE OR
CHANGE OF USE
PARKING
RE(YD I PROVIDED
LOT AREA
PLANNING REV IEWED BY DATE
E] SIGN
oFENCE
( _ X_FT)
REMARKS
ci OTHER
oFIRE SPRINKLER
FIRE ALARM
CHECKED BY �CONSTRUC=N OCCUPANT
TY GROUP
CRITICAL
AREAS SPECVLINSPE N, AREA OCCUPANT v
LOAD
NUMBER REQUIRED [I YES
REMARKS
PROGRESS I INSPECTIONS PER UBC 1108/FINAL INSPECTION REG-D
2
F F F.
f $
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LAZING % 'LOT SLOPE %
:Building Permit City Surcharge
T 6 1
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERUff AUTHORtZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERITY ONLY. ANN CONSTRUCTION ON THE PUBLIC Grading
3 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, ILIAROUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
k: Engr. Review
PERMIlrAPPLICATION: 180 DAYS
916 PERUff ILIUM I YEAR - PROVIDED WORK If, 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 FOR DAMAGES OF WHATEVER NATURE, AMSING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
21 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.' Recording Fee Receipt #
Ir.
1 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 This application Is not a permit until signed by the
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Bulld.ig Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODEflF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMENI�S 0 IGN E DATE
,QOWANSATION INSUFYNCE AND RCW 18.27.
5 i (owhil- IA95)
SIO NE I[ 1 1111 Allf"!, I DATE SIGNED 771-0220 D BY bATE
w
NTIO V_ Off 1333
0
ULI
LAWJFU
'0
NTI
T UNLAW L USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
U
L I SP C1
TFINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE ;1ELL0
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
0
I- I ,V ;, - � I JW?gool '0.1 0 -
PIA 4 r
son �,,.fojjj 4 0
(11,14-1 q -� 0 V!
IV It
of
I r*. I%, I I. . '0 �V4, 1WVg!
iso., Igo; to ; Z, % . I V, 1. 1,
f
of 'i'%N
P, I,
r
k
to)
1, P t
If,
I r
R mCORD OF INSPECTIONS
Em
L P
INSPECTOR DATE APPROVED
I 1 4
d I
k
P
SETBACKS
VAL
I . I I . . I f I- I I I
P
,P
of I
I V I T FOUNDATIONO f 4 r f
k
V, po, Fooling
No
f I VtLI I f
I kI
Wall. 1.. 1, 1- f of If II.j. I
jV,VV,�,,V,,VVf.:II. P, I I I I Z
I...
of I
I go If I I I I I I I I I I I I I I I f P
I V 4 1 1
I I I off I I Pier/Porch
I. . I I I k I I. I. I I I I I I I I . I I I I ok
It t V I I I I It I. I I f I I I I I I Wall I
P. r
I d I I I I
V V I I I I Vi V
I V, I Retainin V.
9
I p 'I k
J'
I_ of IV I I I
f., I. I I 1 .11 Slab Insulatio f I of"' I
n
of
V, ot, I I
t I 1 0 V I I If I. 1 14 1 1
4 1 1 1 1' 1 1 V 4 11 1 1 1 1 1. 1 1 1
L V I I V, f
of I of I
S 1 1 -1 P I I
(i L I of JL I.
I 1 .1 t f I I r I V� I I I I P
I j
.41 VIf I � :� :
Vo V I j
11 PLUMBING f III I; I I I. of 4.1 -4
of, I "I V V.,
I of f I. I I I I I , I I I - I , - I
, IV . , I I L, 1 0 ! I
1 4 1 1 1 k .. I I I , , f I ,
I� I P I ,
of
I I L I I L I I of :.d I 1 0 V_ I.
LL : I , I . I m
L �!I I I I V I 1 1; 1 1 1
4' 1 rthL I I 1 4 of, I I I I I I VV I loo, Undergrot f I
ind f III,
I I V, k... 1 1. k f I of I I I I� t I I F I I
I L I I I r f I I I I I
Vfo� ... I . I 'fI I I
of I I
V` f VIVIV ,I. VI .1 1 1 1 1 1 0
P 4 1 1 f
A If
Rough4n L I f .
I I 'I I I I of I I t I
I I L I IV r I I
V. I
1 7 1 'k I I 1 .1 1 f I t f
d 0 1; 1 1 1 1 1 1 d f I I I I I I I I I
I I I VIV I I I
I ' d I I I P
L If I 1 0 1 1 1 1 1
I 1 1 4 1 If 4
f f I- I I f 1 f I 1 0 1 1 1 -1 1 J I I
Vj� i I . , I - I I I . I i ' ' If - ; I I ' I
I I V V., I: 1 161, Final I VIP I I I. I- I 'Ll 'r, ". . i 9 � I
L.� f .1 VV. Viq� I I I 'I I 1 -.4 � . I t I Cornmferc OPINIONS VIL of
V f '3 VVt I, If. L. I
I . I I L 1. f qk ; V
r .1 P, I
of IL I
I I: L I
I r I f I of I L I I 1 10 1
f r III I or I Vo V I I I V I I 'k, If I
k
of I I : ,
IV I. I
to f
I Vow 0 1 1. � ( 4 P
lot '.t.'V! V
r., IV 'tr Iq � I :;, -HEATING:,.
I . of r
rj V� V I I If I 1 .1 1 . I
I f V. I LI� .)P) . of I VI'VV I I I. I I z
V I; oz I, t I I I I I I I
. , I I I I I I I of
of I r VI
IV I IV 0 w r I
t of I r, I
r of
I F I
Vo',oId I' - 'I- I `VV
III,, of I 1 1, 1 Is I . . .
% If.
of VV'.j so
Lj Vo 'L� I V, Ga Teit I
I 1 4 1 1 4 4 1.
A I
t �'I 1 0 1 f I t I I , I . I (a
I I I ,
4
o
V - I . I I to
I or I I I I If I. I 1 1 or �t. I
fo I V .1 Ik IV%V1 olf das Piping
I I . 4 t I N 11 Im" I If I I �I .1 r I I If 1 1. of
I. I I V r I r, I I wn No.
f . I I I I I V I i of I I I, I; for I f I L I
I d
f- No
.4
F,
L. I.Y k. t a f I f V I IV
L I
o4.L' 1,
If
L I
EquipMent
I t -1 �tNt 4, 0,V. 1', $1 ofoo, P V, 4
III I 4L - I
1. 1 � I V Vy, I I 1 1. -1 If, I I I I I . I. I I I I V, I I I I. I. I I .do V
I I - I r I I I I,
L � I . I . I . of I I . I V foo; IV - I ' 1. 1 . . .
Vo I V r. of V I L
r V4 4 L
I of V' % r LL
If If I
4 V I
I. I, I. 'to 1. 1 of 1, Final r. I
: I%. If I of I. I
IV. of .1 1 1. Commercia
1. 4. I.N I I, V I L - . I is. I
r I , I I I I I I, I r I I 1 0 1 1 1 1 1 1 "I'd, I k I I I I I I r I I
.VV�r � , ; � A � If V; I I I 1 3 1 . I
t I I I I I I : I k . I I . I I �.
I k I I I k I I I V t I - - - I
k I I I " I V r. 1. 1 .1.
% I r I I 'd I I I t �.4 I I I f r lot
t%,V, P I
k j" L r V VV I
I of t I I 'I
I I
f, ._ V, off I . 11 E)ffERIOR
IN ' 01 V V o I I � - I I I, I SHEATHING' V r.. of 2
I I' I V f I k 1, 1 1 1 1 of I I I I I Io I I d wo! I I, I I
V
d rI
. I of I I I I I I . f
V IV IV 1 4 r I V I
I off I I. d I . VV V V
VIA L d
r- I. .'r :NAILING f I
IVI i " I. . I , f . d , q
I. I t I I I I If If I I . I I
r t I t I I I I I I f I I I I I t . C)
r4 I I Z I � . I t I I I I I P I v
I I , I f I I I I I . I f I I I I
I . 4 1 'o t I I V. I I I I - I
I I ij If I I I V, . f I
r I I I . I I I I . I I I I , I ' 4 1 1 1 1 1, . I I V, I I � I . , . I � � I . . I . I , I 1 0
V of I I I - I I . I I I 'I f I - Y
of FRAMING'.; 1
I" f I I I ;L 1 1,
4;VV
L
4 4
d If L I
�mgw& do
0 1 1
I
7,
TE RECEIVED
PERMIT EXPIRES
SE PERMIT
ZONE
CITY OF EDMONDS NUMBER C�2 L9L.,
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
O"ER NAMEINAME OF BUSINESS
TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
COL N
PLAT NAME/SUBDIVISION NO.
LID NO.
LID FEES
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TES 'r PWOVIIQ
RW CPerrM Required
Streed- Permit Reqd
EXISTING — PROPOSED
Inspecdon Required
SidewakRecitilred
1,10WNER/CONTRACTOR
REQUIRED DEDICATION— FT
—1—
UridwWcurid 13
W&g required
M ETER SIZE
LINE SIZEiTNO,
OF RES
PR U RED
113
YES NO 13
i
REMARKS
RESPONSIBLE FOR EROSION CONTROL/13RAINAGE
ENGINEERING REVIEWED BY
DATE
ADDRESS
1
FIRE REVIEWEDBY DATE
1
V6
CITY ZIP ELEPHONE
STATE LIC61SE NUMBER EXPIRATION DATE CWKED BY
VARIANCEORCU
SHORELINEORADB#
INSPECTION
RECID
BOND
POSTED
DYES ONO
S
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
TM TAX ACCOUNT PARCEL NO.
EXP ,
,
,
NEW RESIDENTIAL PLUMS NG EMECH
C MP C OR
COMMERCIAL C�N�
E OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.).
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
L_
PARKING
RECrD PROVIDED
-------------
LOT AREAJ EVAN= TE 06
MILY
[3..k�ODEL �-,&MuLnFA' 0 SIGN
GRADING FENCE
REPAIR CYOS X FT)
REMARKS
10:1 W h,
[3 DEMOLISH'' [3 TANK'? OTHER
El
[:].GARAGE I RETAINIISidWALL FIRE SPRINKLER
CARPORT -13 ROCKERY FIRE ALARM
MVE OF USE. BUSINESS OR ACTIVi EXPLAIN:
CHECKED BY
ST®RUION C&DE.
:7UN
OCCUPANT
GROUP
OF
STORIES
NUMBER OF
DWELLING
UNITS
FRITICAL
AREAS
NUMBER
SPECIAL INSPECTION JAKEA
REQUIRED [:] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC I 08/FlNAL INSPECTION
Q2"
Z,4i1Z1VV6
12MV-1 iX-616 4 1 f4dame
HEAT SOURCE GLAZING % LOT SLOPE %
PUN CHECK NO: VESTED DATE
THIS PERMIT AUT14ORMS ONIM THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLV. ANY CONSTRUCTION ON THE PUBLIC
2 VAYS, MARQUEES. ETC.) WILL REQUIRE
3 DOMAIN (CUMM, SIDEWALKS, DRIVIE
SEPARATE PERMISSION.
PER ITAPPLICATIOW 1180DAYS
116 PERMIT LIMM I YEAR - =DED WORK 16 STARTED WITHIN 1190DAYS
BEE 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 18 CGRRECM. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CnY AND STATE LAWS REGULATING CONSTRUC-
.. AL. NG - WARle A' MOWED THERE91v NO PERSON VVII I BE EMPLOYED
$
I 4n -0 5 tr.)nZ I
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
�re Review
plan Chk. Deposit
Fife Inspection
Receipt #
Landscape Insp.
Total Amt Due
Recording Fee
Receipt #
CALL
APPLICATION APPROVAL
This application Is not a pannit until signed by the
Building Official or hb/her Deputy. and Fees are paid, and
IN VIOLATION OF THE LABOR CODE.40F THE STATE OF WASHINGTON RELATING TO FOWINSPECTION receipt Is acknowtodgod In space provided.
WORKMEM��,CQMPENSATION INSU91FICE AND RCW 18.27. DATE
I OF IGN)7E
Cis] 1A9
SIG (cw� DATE SIGNED
.0101
771-0220 fIELFA BY DATE
NT'o EXT 1333
N�A FU E RB y A BUILDING OR STRUCTURE UNTIL
US 0 CUP
U W LV
L SP S
T; CTION HAO ECEN MADE AND APPROVAL OR A CERTIFI-
I�NA IN ORIGINAL - FILE YELLOW INSF�CTOR`
CATE OF111CCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES