APPLICATION AND INSP RECORDS.pdfDATE RECEIVED
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS zaNE �� NUMBER/-
CONSTRUCTION
UMBER CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS l
AMM I PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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O f O 1� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Pe Approved Required
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",V V RW Permit Requires t3
Street Use Permit Rey'd
CITY EXISTING inspection Required 13
ZIP TELEPHONE PROPOSED
��� ��0 �' �q O Sidewalk Required 0
�. '� REQUIRED DEDICATION FT underground
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NAMEG, METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
Stfo�(cK YES NO 13t7
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Q 13
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C ADDRESS REMARKS z
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CITY ZIP TELEPHONE �N_45?�n�
LYAJAWOOP 80 3 05w 77Y q70 , A< MJV ,g. 7;9 .
NAME CB
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cc ADDRESS
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CITY FIRE ArIE BY .DATE w¢
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STATE LICENSE NUMBER EXPIRATION DATE CH CKED BY VARI CE OR CU SHO LINE OR ADB# INSPECTION BOND
i EO'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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NEW❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ❑ ❑ ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR �
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COMPLIANCE OR �.� 7`)i7+ L.17 Z5 f� '7e- 0.7� . z
❑ ADDITION COMMERCIAL L. CHANGEOF. USE z
REMODEL ❑ MULTIFAMILY L� PARKING LOT AREA PLANNING REVIEWED BY DATE a
SIGN REQQ'D PROVIDED
I REPAIR ❑ GRADING CYDS FEN ' m REMARKS
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❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING
SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
��LIC� IoUS ��S'fi?'U-rl D►�1 Q �c �nn�QL� CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT
GROUP
3/9hij F4
c NUMBER NUMBER OF CRITICAL "
OF I DWELLING AREAS SPECIAL INSPECTION AREA OCCUPAN
O STORIES UNITS NUMBER REQUIRED YES % LOAD
DESCRIBE WORK TO BE DONE 03Q50 o
REMARKS z
�E�iR QEIv14 L 4� EX157i G PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109FINAL INSPECTION REO'D 9
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611 v 7Y 5PA4' A S�N�k�13!c4VOL G�435R.A�MS, $1, 5�, 7 �
AL Azem:! 9 k11LL$'�C�055 Description FEE Description FEE
1* `Jt �r /n i$1/�iVUlr Plan Check `" State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit �. City Surcharge r
1.8 �0 90
PLAN CHECw N VESTED DATE Plumbingj Base Fee . J
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t7 BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE GradingDTI
SEPARATE PERMISSION.
Engr, Review
cc W PERMIT APPLICATION: 180 DAYS z
CL PERMIT LIMIT. 1 YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
IF
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fife 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�� 'l Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
4.
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE LandSCa e InS 5z /
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE p p' Total Amt. Due
= NOR LIMIT IN ANY, WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APP VAL
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 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 COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGN DATE
SIGN RE (O AGEN77 DATE SIGNED (425)
771w0220 L SED BY TATE
ATTENTI N EXT 133.3
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL / I / L v
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU
ORIGINAL
46
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110, PINNKK--FILE Y-• OWNER GOLD YELLOW SPECT -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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DEPARTMENT OF BUILDINGS
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t Al 615 Glen Street Edmond A Building OVfhlt #: 2005=0321
Occupancy established by this coo ficate: Dwelling Units "N/A'"" No. Stories: 1
AWB/SI/14, a Ty nstruction: VB Sprint {; Basement: No
Maximum ccupant Load ? k (Per IBC 1004)
Roorkcapacity signs, Fust remain posted at all times,
Owner of Building: Communit Chris `� '`-waamw monds WA 98020
THE CommunityChristian Follows 'EEN 0481 "? Iq ( MPLYING WITH THE REQUIREMENTS OF THE
2003 EDITION OF THE, INTERNATIONAL BUILDI AS ADO& D; y,oYi`��. n �`Ft��'I .'.. OUP AND DIVISION OF OCCUPANCY AND THE
USE FOR WHICH THE PROPOSED OCCUPANCYI SIFIED lt
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Issued this 15th d �A %;.� A'Sti'er 2005
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CHIEF BUILDING OFFICIAL
BY:
This certificate shall be posted in a conspicuous public area and shell not be removed, mutilated or obscured an ell be maintained in legible condition at all Ames. Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official,
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425444-0930
DATE
ESTIMATE #
11/30/2005
973763
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LIPl tiG HEIGHT , CORNER NW: 95.00 MAX HT LIMIT: 25' , 125.10 '—`—" 11 Ir,.. __ , -,
ELEVS: NE: 100.33 PROPOSED HT:a'G/= tz3*60 THIS WILL G=REATLY REDUCE -THE IMPACT TH4' CHURL
SW: 100.00 CURRENTLY HAS ON AREA PARKING.
SE 102.08 AP IROV�LI �'I"f��Nif�lc., NO ADDITIONAL PARKING IS PROPOSED IN THIS PRI
EXISTING FOUR STALLS ON THE CHURCH PROPERTY
AvE. BASE ELEV.: 100.10 '� =-12/!?! �.t RETAINED, ONE STALL BECOMING HANDICAPPED AC
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