20050706.pdfzql
DATE R%CEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
Q)U_NER NAME/NVE OF SINET
99 i7l Rip I s,7
MAILING ADDRESS
C,
CITY :I
ZIP TELEPHONE
Z"T --6
NAME
ADDRESS
CITY
ZIP
TELEPHONE
CBL 4
�z
ADDRESS f
2-/ 2
-S*—/
7 ci Y
ZIP
TELEPHONE
c/ 2 s--- ?
�-7
-1 f�Vv,
STATE LICENSE NUMBER EXPIRAIION TE
SqECKED B
- z?
U! � f C- � -,!! z-) /-- 1/,
7, "
14 4� 1
PROPERTY
TAX ACCOUNT 13ARCEL N9. ��=
o.53 414 /0*
/�Ozp/,2
NEW
RESIDENTIAL
PLUMBING/MECH
ADDITION
OMMERCIAL
XC
COMPLIANCE OR
El CHANGE OF USE
REMODEL
MULTIFAMILY
_y__SIG
GN
RE GRADING
PAIR CYDS
FENCE
1:1 ( X FT)
E]
DEMOLISH ri TANK
OTHER
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, USINr R TI"VXPU
U)
uj NUMBER NUMBER OF it
OF DWELLING
h
o STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
PLAN CHECVrJ
GLAZING %
PERMIT EXPIRES
USE PERMIT
ZONE iYo.
NUMBER,,�/
.JOB
ADDRESS tlk / -
14�e
SUITE/APT#
fD
LAT NAME]SUBDIVISION NO.
LOT NO.
LID NO.
15
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP Artrucyad E3
RW Permit Required E3
Street Use Permit Raq'd CIA
EXISTING PROPOSED
Inspectlan Required
Sidewalk Required Ij
REQUIRED DEDICATION FT
Underground
E3
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
ui
REMARKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
a
z
A
Lu
-7
ENGINEERING REVIEWED BY 0
(T E
ev 111 ?bos�
FIRE REVIEWED BY DATE W
VARIANCE Oil CU
SHORELINE ORADB#
I
I INSPECTION
BOND
/�r
IP "V_f�
RE '
10YES 0
POSTED
--'
$
SEPA REVIEW
SIGN AREA
C, C4 VM FliGaT,
L;UMVLh I t: EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSE
,
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
A-
z
z
z
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
10-
5
a.
REO'D I PROVIDED
,�, I
I al 0
REMARKS
CHECKED BY JT'�Pp
CRITICAL I �
AREAS SPECIAL INSPECTION
NUMBER REQUIRED [:] YES
REMARKS
LUATION*
Description
Plan Check
LOT SLOPE % Buildin I g Permit
VESTED DATE Plumbing
6V':,) �0 IF :�4 1
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT* 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
'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 ANYAND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Landscapeinsp.
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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
Recording Fee
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
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
FOR I GfIEC
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
(425)
(OWNEff1,jFM%-`N:�J)
DATE SI ED
GROUP
OCCUPANT
LOAD
a
z
IONS PER UBC 108/FINAL INSPECTION REQ'D �
I — . � . — . .. % . I Z14 , /, 5M
I
FEE
Description
F E E
State Surcharge
city Surcharge
Base Fee
Plan Chk. ID 0"" _je_4�15_
Receipt #
Total Amt. Due
I , d02
Receipt # -7,21'4�
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Olficial or his/tier Deputy: and Fees are paid, and
receipt is acknowledged In space provided.
FI IA S SIGNATU DATE
1 0 M A' � I A k- , f 3,yjj .-7/,
�=7 ci
771-0220, REL cl
ATTEWTION Off 133
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFP
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPEfCTC
PINK - OWNER GOLD - ASSESSOR
z
0
4
0
IT!
-1 -n
3:
M
M
0
—10
0 C:
-4 r.
X M
M z
0 _n
n
M M
0 6)
0 r,
0 M
M 0
Z
X
z
0)
z
0
M
I
I
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO:, PERMIT COORDINATOR, BUILDING DIVISION
FROM:. FIRE DEPARTMENT DATE
PLEASrSIGN
nvl� DIVISION DATE
ENGINEERING
'ASr SIGN
0
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT MIL
r-z
M
SITE A.DDRESS____J,0S-
M 0
PERMIT ADB# DATE INSPECTED �?Las:: 7- �. 2 5
0 C:
M
M Z
DESCRIPTION OF WORK TO BE INSPECTED
C z
A field inspection was conducted to determine compliance with -approved plans. Final approval
X
V5
denotes that there are no objections 'from the above signed, Department, to the release o.f
0
PERFORMANCE BONDS and the granting of
M M
GRANT FINAL PROJECT APPROVAL
0
0 M
C CD
- -------
9 Cn
Q 0
GRANT PROJECT APPROVALWITH CONDITIONS NOTED
.0 Copy of. CONDITIONS given to owner/contractor by. inspector
0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
M
0 Copy of CORRECTIO N NOTICE given to.owner/contractor by hipector
2.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAI, PROJE�CTAPPROVAL
Date . Signature
1:te111P:b1dg:fort11s:ocaprv1 3/25/04