20051036.pdfI —DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
R C— �_� 1, A CZ s, C�
M MAILING ADDRESS
C�c r("
J A \J
-2- 6: &J
CITY TELEPHONE
Zip
X-0
NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME.
G�m-t--Pun,(2.160
�j
CBL #
ol000.
'ADDRESS
,?-700 NC� 1,LqV4
<�l 50-re 11
CITY Zip
ELEPHONE
STATE LICENSE NUMBER
EXPIRATION DATE
Y
1
F I RE 0 S IL 09%W)
q 00 -7
PROPERTY TAX ACCOUNT PARCEL NO.
El 9 Q
NEW
RESIDENTIAL
ArPLUMBIN C
MECH
ADDITION
0 COMMERCIAL
COMPLIANC R
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
FENCE
REPAIR GRADING CYDS x Fr)
DEMOLISH TANK
OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITYJ_4Xe4AIN:
PERMIT EXPIRES
bSE
PERMIT /7
ZONE
NUMBER
2
JOB
ADDRESS
"44
C)
/APT #
LVI
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
JESCP Approved-
Rw Permit Required
13
Q
Street use Permit Roq'd
E3
EXISTING -
PROPOSED
Inspection Required
Sidewalk Required
E3
REQUIRED DEDICATION-
FT
Underground
Wiringraquirad
METER SIZE
LINE SIZE
I
URES
PRV REOUIRED
YES
REMARKO'__'�"m
A 'e, 7, r. .1VT -if n? I I of 14
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
.ARIANCE OR CU
SEPA REVIEW
GUMPILF11: EXEMPT
EXP I
4 T 1-burn
T11 AV -
ipmfgath VIIII
REMARKS
CHECKED BY ITYPE
SHORELINE ORADBI I INSPECTION I BOND
REO'D POSTED
E]YES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
SIDE REAR
ances paf;�
0
NUMBER
OF
STORIES 2.
NUMBER OF
DWELLING
1 UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPIIECT105N ARE
REOUIRED YES
3 —ffA
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC
'T.WSTALL LOM WS 15ic-Ok/E-Ky
WT6 6,911srIO&
G PtS
01�INNCI VALUATI =N
$
Description
ir*J��ALLEO I NJ OAS OEM'
s 6 e ITT-rAc.#C Plan Check
HEAT SOURCE GLA71NG % LOT SLOPE % Building Permit
F
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTFILICTIOM ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
3 SEPARATE PERMISSION.
1: Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
UR
OCCUPANT
GROUP
OCCUPANT
LOAD
z
E
W
z
z
5
z
lummi
,S (Fr.)
REAR
z
INSPECTION REG'D 19
:3
M
FEE Description FEE
State Surcharge
City Surcharge I �*�
U)
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Plan Chit. Deposit
2
iALL
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGEN FS FROM ANY AND
CLAIMS FOR DAMAGES OF WHAT EVER IIAJ URE, ARISING DIREC rIY OR INDIRECI LY
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
9
FROM THE ISSUANCE OF FHIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
21
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PHOVISION.'
Recording ee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND T14AT I AM THE OWNER, OR THE DULY AUTIIOTIIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN DOING 111E WORK AUTHORIZED DIEREDY. NO PERSON WILL 13E EMPLOYED
IN VI'6LATION OF THE LABQR CODE or THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI&AN1,N4RANCE AND RCW 18 27,
DATE SIGNED
OtM/L_-1!24/14-t11 I �k- V�f I . wm C,
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building 011icial or his/hor Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknowledged in space provided.
D
OFFICMRF J1 7E/
(425)
771.0220 RELEASED BY ibATJ
ATTENTION EXT 1333 --------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING Oil STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04i02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
z
0
A
0
ITI
--I -n
M
C
M
0
10
0 C
--j K
x M
M Z
1c) --i
C
0 -n
M ITI
0
0
0 M
C cir)
9 Cn
M 0
Z
X
z
z
0
I
0
IT!