20040810.pdfDATE RECEIVED
PERMIT EXPIRES
SE
CITY OF EDMONDS ZONE NUMBiER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT"
ADDRESS
OWNER NAME/NAME OF BUSINESS
�L PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
v�•zab
LID FEE S
MAILING ADDRESS TESCP Approved Q
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required j]
P Street Use Permit Roq'd OOO
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required p
Sidowatk Required 0
REQUIRED DEDICATION FT Underground
wiring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
r7
YES ❑ NO ❑ _
W
ADDRESS REMARKS Z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME IcB
rn L 27:4*t'/ CSW_ f`iti�. 3 ENGINEERING REVIEWED BY DATE
ADDRESS pWjNSPECTION REQUIRED
FIRE REVISED SI15BTREWDATE W¢
CITY ZIP TELEPHONE
� • SIDE seaBR MUST ss p® cnrAT
STATE LICENSE NUMBER EXPIRA ION TE C BY VARIANCE OR C L ADBM INSPECTION BOND
REQ' aOSTED
��711�� � Q It 70 Y
SEPA VIER BIB IGHT
PROPERTY TAX ACCOU PARCEL NO. COMPLETE EX ALLOWED PROPOSED ALLOWED P�QpOSED
• ��� � Oy®D P iCIB TT
EXP
NEW RESIDENTIAL PLUMBING / MECH LOT COVERO SETBACKS (FT)
)
ALLOWED PRONHMrOXA'
F =
COMPLIANCE OR ' O �M REAR
ADDITION COMMERCIAL • ON REQUI EMENTS z
13 CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE n
REMODEL XMULTIFAMILY 1:1 SIGN REQ'D PROVIDED
REPAIR 1:1 GRADING GRADING O FENCE X FT) REMARKS .
DEMOLISH TANK OTHER
..n..n.- �r A I L &M I^,uL, , nnn,uv, rn
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
CHECKED BYT GfJ[f f �u�.urnry r
(r,I� GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED ❑ YES LOAD
REMARKS O
PROGRESS INSPECTIONS PER USC106/IBC109/IRC109FINAL INSPECTIREO'D g
ON
N�/me � M�1 /� 7� r i /J,/7p' 110
VALUATION
��� ✓''� $
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % —
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
S DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT: 1 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 N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE a Landsca Ins Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE p p'
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Recording Fee Receipt k
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- CALLThis 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 Fees are paid, and
IN VIOLATION QPftRjE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S %MPEAPATION INSURANCE AND RCW 18.27. DA
OFFICIAL SIGNATURE
SIGNAT NER R T) DATE SIGNED (425)/aWmi
771=0220 RELEAAD BY DATE
ATTENTIO EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW -INSPECTOR
PANCY HAS BEEN GRANTED, UBC109/IBC110/IRC110, PINK -OWNER GOLD -ASSESSOR
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I'l1liLl JUUhl1l LLt\N AIIr,.VLIVI:Y IJllt 1tet:elv,c+1
v Case No. .-- i
V In i mmm1,-;tree(. Suite 5(111 t • '
200.402853 ..�:
Seattle, WA �)Slur.zu3 we
ti: +w� wwvti'•1 seleanair,urg
�mtau..1n*4w.0 NO'T'ICE Or INThNT
"I;;+are)• f!v� Unl; .
itvCnr'!' GS•t+ Unit' +
\ _P.ruicc( ;l'� nc.: f. riuhlcr A�he�tn� R�+nu►v l 2" able Asbestos Iicm,+val & Dcnwlition 3. 1)emuliti+){i Only_
V;• l l '� —
Propr•ly Urvuer: �Y /Ni.)r� 1 (11A I'ht�nc_ 4'_ � ill ( UI)t)
er " =
I` lr+a (- (:it Mukiltt �i State W:� l /i 9s2
Mailing Address: 7..7 bacct (,nit '
14.11:IsJ HINT e'LB.IItt.F. mis Ir•n.t. l,F. r01 •!r ttb•T,ut, +tart I,V(: 1r �Htt '
(( \tiliestus Owliel ,130: Kit Baker
I (untractor:
Mailin ,,lddtt:ss'. 11115 >1" Place South
Phinte: 20o-703-5522 Jut) �)u;: ZO
-- I �
E ax: 20G-7G3 2,17!) 04 i ill 0
City: rilkwila State: W A Zit: 9S 173 fTl
Site <.'tn': Gdmonds'►S02t)
`` Address: 611 Bell Street - N --t
Site —� - Local Phone: 425-501 0003 M
lvlauas er: Mike Nlassev _ C 0
rn
- \tas Friable Asbestos Idcntificd'?—�1'C, Nu- -� 0
1?, :\she sues SurM4 K
vey or No. of Pate uI Asbestus
r . j,• 49 Was Nunfriable Asbestos ltlemittedY �1'es Jl�u � C
I tJ-Nlat'1 f'resutned Slructttrt.'s: I Sttrvt v: of the strr�c:v tt-lr�tt /i icthltc asbestos
2
13ttilding i ` (';u'titicati,ln 1t: OLV41 p� rn
Inspector: GV- Gx)i. Date: Z • 22 - G j' bus nor he r n idr.ntilicd, p
i
An a111S/l:l Jurvrt is required bet/i,re tell JrannNliun /ern%eel.+ V�lIllIlIlIll_ _ _ D Z
i . llernuliliuu Start No. of 1. 1'ranitns l ire (Lill Fire L)cpl:) "MINE ME
r
ture's: 1 ?. ❑ Ord(red Uzmctlitinn (attach co . ofOrder)MIMMlnfarututiut ])ale: 10/)2!1)4 1.13truc'
At.crrr rlruu,liriun conrr,a nrr'.r enrol«t},, r,ddre.+.r on hark. Will nuttfriablc ash( los he loll In place ihtrtut,' (lenulY 'J l c V�' 0
I ' [.)rmnlittoit �1
-intraclorEi 'i` If ycs, list type and clt)'•MINI
x rn-
_
Work Days
M T \V *1 1: Sa Sit rn
FG, Friable r"bestos ('lours: 7:00 A - 3:30 P. 0 N
l'ruje( luformutfon;
Sint Date: (� Completion Date: _ r
-- Will all friable risheslns U Y' C m e
I'C+tlal (1ty, to hi (trmuveii: Linear rt. St uare rt, materials bt 1'entuve(1`t
liurlcr`,hurnaet Instilatitin Uuct Insolation Pipe Insulation iy pruuting faints I?laae r I't uure+f C o,uut{t� _ t Z n
z.m
_,� l:entcnt l3uatd l'cnient Pipe Friable Flooring n �'riablc�It�djit g atirial Other � D
oliticaliuu Period ['rujeet Ucmolitian I.
ll. r\5bLstost'Deniolitioli Project Cate2orics: LKe j'da�- i � htc Surch; e
1. Single -Family Residence (Owner-occupied): RCP al To 0) -tit :�.. `15
], 7. t.J Li A. f t roe Notice
Z l{
:\t;bc;tus Remov;tl Prt>j,:ct C)uly G L' li. lO Days":
I ki�J
Demolition nl Protect kwith Ot• \vitliout asbestos t'CI110Va1 pl'Q)CCt)
-*(:\sbcstos reinuve can bet!iu u on tiotiticatiun; demolition rntist wait 10 dans) _ N
l e Stn /c� until ,resident rs is awned b): one fanriN who (rets been yr will be «situ thi resic/c�nutr us thc'Ir tfr�tttic'r1cr, Jhr ,then t' hu.l,;.t Z
INutt 1/ J t 1 )
it nr !Il ntup hr e:hr-ekt rl../f this is: rrot Ott Owner-urcupied residence, one of the' eate'A,oriev lister( bedu,n nru.�t b« uscrh i �ru;,Ir.lrrrnrly 0
re sielence due Ont iiu'hie/%d'ental I,rnprtJ`ty, mIllulti-!uulily !«lits• of Ott►, tni.cetl u teilrlin.' V l) Days — - — X200 (�
2. All (�Iher l�enwlitions:with no Asbestos removal orNcntfriable As only -- -
As�estos 1)cuto m
Fri:thlc Asbestos Projects (outer than Single Family Resident(: - —
�> l0 _ 25) linear feet Old/or _ 48 - 159 square feet of asbestos100
PriorNotice. tODays $100 $lUU
,. l0 Days $200
4. 2G0 9')9 linear feet and/or 160 - 4.999 st uare tcet of ashrstos 10 U;ivs 5750 S25t1
S n _> 1.000 linear teet aucVor >S,M)o st uare test of as
Prior Nutit t I'wtrc I'no)rcl I cc
Eurrrtt+ u�v :\sbts, ), l'rujt ct ur (sntergcnt y l)aniuhttuit l roVecl --
I I�in:.Ic I amih Itr::u1, n cs are ..vclultl li_nnt wntee^fern v h t ht,�cvi:r, pmper uwne r5 nu+st tnrvuh• :+ wrote„ cn erµencv rc+h+c l) ,— ---
__ _ _ �� — __ --- ---- 1xc U I V i
y I
t' a nil' r nauun Outs,( in this noiilicatiot L supplemental data i.• to the best ul my Ln,+,vkdr;e, accuruc Sc cunq+le+c. :\gen �' I
I I7�� J)au, •v,u+r�d Jr i
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I'uttcl tiuund (•Juan Au' AKetIy I"nrnt NO : ttn•Iou (ltevired IAA) Tti
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