20050067.pdf� -_1 r-
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
8119 190 St SW
CITY ZIP ITELEPHONE
Edmonds 98026 425-712-9234
N AM E
ADDRESS
CITY ZIP TELEPHONE
NAME
'FAqt- Waf-pr HF;af-pr
ADDRESS
12601 132 Ave NE
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
J013
ADDRESS 8119 190 St SW
SUITE/APT#
PLAT NAME/SUBDIVISION NO. LOT NO,
to NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
Rw Permit Required 13
Street Use Pomit Roq'd 11
EXISTING - PROPOSED
inspection Auquifed 13
Sidewalk Required E3
REQUIRED DEDICATION- FT
Underground
wiring required El
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
93
YESE3 NO 1:1
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w
REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
E5
In addition to the required
CEIL pressure/relief valve, an approved
X2 �j
ENGIN1@jffe&`M DATE
& V I . fibsion tank shall be
cl ZIP TELEPHONE
Kirkland 98034 425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE I CHEC
FASTWHC052DF 2-16-0-Al dI
PROPERTY TAX
ACCOUNT PARCEL NO.
00481600200601
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
El REPAIR
GRADING CYDS
n DEMOLISH 13 TANK
EDGARAGE
RETAINING WALL
1:1
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS 0 ACTIVITY) E PLAIN:
e-'
NUMBER
NUMBER 6r
OF
DWELLING
STORIES
UNIT
DESCRIBE WORK TO BE DONE
1;
FIRE Lu
DATEI
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
BY REO'D POSTED
I 0YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I
PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
SIGN REO'D PROVIDED
FENCE
( — X FT) REMARKS
OTHER
FIRE SPRINKLER
FIRE ALARM
CaDE OCCUPANT
M�� GROUP A/0
CHECKED BY jTY7Pr4NQTRUCTION
CRITICAL
AREAS SPECIAL INSPECTibN AREA OCCUPANI
NUMBER REQUIRED [:] YES LOAD
r hp-ai-in r REMARKS
]PROGRESS INSPECTIONS PER UEIC 108/ IBC109/IRC109 FINAL INSPECTION REO'D —
9
5
00 btu's IN
M
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOU FICE 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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: 180 DAYS
CL PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
q IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
9 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES,.AND AGENTS FROM ANY AND Fire Inspection Receipt N
0 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
!3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
3XI Recording Fee Receipt #
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 APP ION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATIl?Y.P4,S1�RANCE AND RCW 18.27. DATE
[OF �ALS Z419NATURE
SIGNATURE [OWNjE �GEO.4_ DATE SIG ED (425)
'7aw /��zi
(>/p S 771-0220 RELEASED BY �E
A77ENTION I EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU- ORIGINAL -FILE - YELLOW- INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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