840252.pdf.r
USE PERMIT
CITY OF EDMONDS LONE NUMBER ' V lJFid PV /1, {
f CONSTRUCTION PERMIT APPLICATION jGE r j
r,IAME IOR NAME OP BUSINESS) ADDRESS �C.,J V j c✓ ,l A /• ' , 7 ,'
LEGAL DESCRIPTIONN CHEECCK SUBUIVIbiUN NO LIO No
IV. C
w MAILING ADDRESS 11
o 303-00 5r
4W_ TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
f CITY z
EXISTING _ REQUIREODEOICATION.
Y 1. PROPOSED
NAME
111
RIGHT OF VJAY CONSTRUCTION PERMIT REQUIRED w
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U ADDRESS STREET USE PERMIT HEOUIRED Z J ,,
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U SEE ENGINEERING MPAO DATED. - _ _ - w :I .I
a CITY NUMBER SEE PIVJ DE PT. REVIEW CHECK LIST DATED
REr ARKS '
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I NAME /
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¢ CITY TELEPHONE NUMBER F
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c; A.?F LfC NSE NlJt.18EN CITY LIC".E6:SE NUMBER
SIGN AREA ENV REVIEW ADD NO ,
( uoWED PROPOSED ESE M1IPT
Legal Description of Property • include all easements rovu'LT r:-
(show below or attach four copies) SHORELINE u
VARIANCE OR CU PLANNING REVIEW BY DATE 1
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YARDS LOT COVERAGE _ -
O - FRONT SIDE REAR ? -
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J r—E REh1AHKS �
l�J NEC:' RESIDENTIAL PLUMBING I
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ADD)ALTER NOf4rR SIDENTIAL EJ MECHANICAL -----___-..-
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REPAIR L_J RETAINING CVALL SIGN
CHECKED BY i T\'IIE Or CONSTRUCTION CODE HEIGHT I
II EXCAVATE El PENCE
DEMOLISH 21 OR PILL _. FTi
PRE MOVE INSP; I�I SWIM SPECIAL INSPECTOR AREA CCCUPANCY OCCUPANT '
COMPLIANCE I.$P L.J POOL REQUIRE[? GROUP LOAD
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C, NA.'v P.E ?F �:OP.n TO BE DOGE ,ITT AC'•i .QT PL A.':.
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VALUATION FEE
Thi$ Per, -)I! :: :efs III ork to be done on Drlvate property ONLY. GRarnr.G=:._
inn the GUbiIC domain (CUTbS. $IdewalKs,
_tC `:III re0LI1,e Separate permiSSl n.
at r �0 Da,
Pei n: i Limit: 1 1 L Pri.v ;ed VI`Ork is Started II"' hm Too Day$
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2n1, On he half Of his Or her SpouSe. `Ic:rs. assigns and j..
I ssor5 L ir,;e-es;. agrees Indemri`I,,._'er.d and ho;a
l arrlles$ the C1;": 0' Eamonos %vas'?;nG cri. its cf`tctal S.
S > >- r_, r n,p-t rl 1 !� n
cmp10\ees. a�t� ag:�n f nm a y d a,' , alms o u� gages of j
c whatever nature. arlSitlC direCtip Cr indirectly horn the Issuance i <
T Of this permit. ISSU?nC Cf this OBrfn It Sna!I ^..: L-e aaemed to
inodlil, •.aive or reduce am, requirement of an, .. crd1nInnpe
not lnl 15 ar'! ;. a'. t''.6 Ctt)'S dO,Lty' 'Ci cn�� _ Jrd',nan CE' a ' 1
TOTAL AMOUNT DUE IT—ac-;' v.✓ IVC- J
proolsio^.'
I hereby ackn Olvledy'e tna; i have read tms a O'i�:at!on: that the '
information Cr en is correct. and that 1 ar- the o'.:ner. or the duly 4TTENT!oN APPLICATION APPROVAL
lulhorlZed agent Cf the oItI I agree t0 CCm•_r with city and
""T This application is not a permit Until
slate I&.vs fey U latl^c :on StruCijcn ano !n ciOmg t1.`'e work iUthoriZ- a ES t I
ed thereby. Inc ne e cmpb _ D a C of the LabOf E signed by the Building Official Of h15
R- :-Ec Deputy; and fees are paid, and receipt is j I
Cade of the Stilt, O Vrr..Sh ^ ;tOn relall .g tO `%.C. r IrIMen'5 COmpensa' .
tlon InsurarIce. acknowledged in space provided. t i
OPFICIA 'S SIGNATURE
CITY O
It
tj V 9 d q EDMOND' S (
ATTENTION
IT IS UNLAV� FUL 'J 'SE O i`CC'j � � .. � ;JG ^R STRUCTl1RE I
UNTIL A FINAL lvbrLCT10N AS '-E E N M APJD APPROVAL OR ORIGINAL — File YELLO`AI — Inspector
A CERTIFICATE OF OC\. "r'A% .1 n�S S __ NTED. U5C APR
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CiIAPTER c. A R Ir9d84 PINK — O':rner GOLD — Assessor
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ENVIRONMENTAL CHECKLIST APR. 2 ��4 {
A. BACKGROUND !
1. Name of Proponent !� /} n t e L rriCf /(lCli�t'y' E/�
.3613 -
2. Address and Phone Number of Proponent S�3?6
� � �a`�'
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3. Date Checklist Submitted /qSw3
4. Agency Requiring Checklist iF &A)
5. Name of Proposal, if applicable J-" C.• 1-�Y 17f- (S-Cl/heileAi iS
p 0)� 0 F ZW Cl t t-f < I es -
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6. Nature and Brief Description of Proposal (including but not limited to
its size, general design elements, and other factors that will give an l
accurate understanding of its scope and nature: !
_o Ll 6 61 r V. Z CCbO 1 (�� t . L J e ez'Z?
rep �
7. Location of Proposal (describe the physical setting of the proposal, as
well as the extent of the land area affected by any environmental im-
pacts, including any other information needed to give an accurate under. {
standing of the environmental setting of the proposal):
Stack) �.�C� 1:_Nc SfiC' S
8. Estimated Date for Completion of the Proposal
9. List of all Permits, Licenses, or Government Approvals Required for all
Proposal (federal, state, and local — including rezones): i
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10. Do you have any plans for future additions, expansions, or further i 1
activity related to or connected with this proposal? If yes, explain.
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11. Do you know of any plans by others which may affect the property covered
by your proposal? If yes, explain. -�
12. Attach any other application form that has been completed regarding the {
proposal; if none has been completed, but is expected to be filed at j
some future date, describe the nature of such application form: ,
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USE PERMIT p '�
CITY OF EDMONDS ZONE NUMBERU+�;r(���G
CONSTRUCTION PERMIT APPLICATION JOB
NAME (OR NF 11AME OBUSINESS) ADDRESS c4
Ald M c 16t. I LEGAL DESCRIPTION CHECK SUBDIVISIO!: NO LID NO
Z MAILING ADDRESS
3C3
CAT+ f 4 TELEPHONE NUMBER
/� PUBLIC RIGHT OF WAY PER OFFICIAL STREET IAAP
�'1� 355-3 L/ EXISTING ... _._.... REQUIRED DEDICATION
-�I'_.
NAME PROPOSED
r RIGHT OF WAY CONSTRUCTION PERMft REQUIRED w
w ADURFSS STREET USE PERMIT REQUIRED Z
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U SEE ENGINEERING 1AEA1° D!D':rEw
a C!TY TELEPHONE NUMBER SEE PIW DEPT REVIEI': (,HECK UST DAI ED
RE ARKS
NAME
ADDRrSS
r•1 E. T SIZE BU LLSIZE FIXTURE UNITS
¢ CITY tELFPHCl1E NUMBER cc
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STATE LICENSE rJll!ABER CITY LICENSE NUMBER �
SIGN AREA FNV REVIEW ADP. NO.
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property • include all easements
(sh°v: below or attach four copies) SHORELINE o
01, .
VARIANCE OR CUT PLANNING REVIEW BY DATE
U
w
a YARDS LOT COVERAGE _
at FRONT SIDE REAR
REMARKS a
LJ NEW LJ RESIDENTIAL l! PLUMBING
ADDIALTER NON RESIDENTIAL MECHANICAL ----"
REPAIR El RETAINING WALL SIGN _
f EXCAVATE FENCE CHECKED [JY i rl'PE OF CONSiRUCiICN CODE HEIGHT,
t�l DEMOLISH 1/ ti OR Fit-L. �. ... > FTi I f (LA ""� C�
PRE -MOVE INSP • SNIP., SPECIAL INSPECTOR AREA OCCUPANCY
OCCUPANT
COMPLIANCE 1N$P. POOL REOUIe..EU GROl1P LOAD
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L---� SIDE SEVIER L� WATER LINE REMARKS c7
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✓%'!U!`.RER 0'r STCEiiEB. NUMRFROF
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o UlveulNL:
OUfVI: J
OF ::ORh TO SE SOr:E •ATirIO. PLOT PLAN
i `i ALUATION �FEE
.1 Gi , ec.., PLUMBtt;G
This Pen- :1 covers I:pork to be done on private Droperty ONLY. C'RA�_!::_t •� ,L
An ,ru or. public dorr,alrC 1,rb5, Sidewalks,
e. ' 'ili requireei5parate permission. —.
310 Da. c
PL;m'„ Year - Prot.ded VJorr, is StarR, lJrthim 180 Days
Gil ^aif pt his or her SpoUSe ner5. aS �Iq nS an0
c r .T ao. Les to Indernn!tc o.efend nnc 'hold
`afrlle ihc'. CI L1 Ed n'On05 1ti•ashirctor. IT pr`,iClals. r-
t empio%cos. a':d t, .. t5 from any and all Claims .or damace5 of �i
tVhatever nature, 3715ing dlreCtiy Or in•dire.:tlw `.rpm. the issuance
of this (ler:mq ISSL`anCe of ihl- Ccrmit Sha•!l nor „e tyaenTed ro
m00!f %%aive _�r r�,—Ci c Any requirement OF : r, Ordinance
In -
nor °.ln1!t L'i an; .. Ins C,t... 5 abl'kTy To En.L j ar ord!naR Cc' —
Oro.is.or•... TOT=," I AMOUNT DUE--,_F_.;� �,...i A lVt-_7
I hereby' ackno lecge that I ha:e read ; . 3 ri gripe: that the
information giver S correct, and that I a.~ T _ _,c e or the duly ATTSNTIOt, APPLICATION APPROVAL
authorized acenr of the oo,%rler. I agree to com : •Ivith city and
stale !al;s regular OonSrru t ; n; : rC In doiry the cork autherir This application is not a permit until
ed the'ebr, no perScn Wail De en;ployeQ in ,iat;; n of the Labor 4 signed by the Building Official or his
Code Of the State \`:as' :hutch rale,in0 to1'or men s ComDensa- _- Deputy: and fees are paid, and receipt is
Lion Insura-C:= acknowledged in space provided.
O9FICIAr SIGNATURE
EDNIONDS
ATTENTION I`
7T IS UN_A4`rFU'_ `0 LSE
Oa. OCCJ='i 4 SLi L I+iG OR STRUCTURE
Li,NTIL A PINAL 1%SPECTi'ONI _Y ,.,DE a`.r PPRO'v'AL OR ORIGINAL — File YELLOW — Inspector
CHAPTER PINK •— O:vner GOLD.— Assessor
A.
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1 . Name of Proponent 6 l4 n / e 41)d Mom I C'v"
2. Address and Phone Number of Proponent 303 c sr%S� ��'55�33��
3. Date Checklist Submitted 23. /1 3
4. Agency Requiring Checklist �r
5. Name of Proposal, if applicable ' ry o F Eekio i?ds' iS
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Lo o, r� `'1 t`�1 V J' j // C/ I t-f <�' ! fes -
6. Nature and Brief Description of Proposal (including but not limited to
its size, general design elements, and other factors that will give an
accurate understanding of its scope and nature:
(OW 6L"r I"CZccbpg L.o 7" C.DCCCLea c;�t �.�� ,�� St1e�r�
`7 � / �. - `� .� �' ��f�• L' (f c�<'�J)� r.�7'k7S� Gi.i� : %�U � C:� l �Yu r'rt f �8� 1 • �5`r�
7. Location of Proposal (describe the physical setting of the proposal, as
well as the extent of the land area affected by any environmental im [
pacts, including any other information needed to give an accurate under-
standing of the environmental setting of the proposal):
l/ C. :vt� L:� LG�CK <� rry \4SaIsA eS 1,jeCres.
8. Estimated Date for Completion of the Proposal
9. List of all Permits, Licenses, or Government Approvals Required for all
Proposal (federal, state, and local — including rezones):
10. Do you have any plans for future additions, expansions, or further
activity related to or connected with this proposal? If yes, explain. �Gy
Ills Do you know of any plans by others which may affect the property covered
by your proposal? If yes, explain. -
12. Attach any other application form that has been completed regarding the
proposal; if none has been completed, but is expected to be filed at
some future date, describe the nature of such application form.
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