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709 3RD AVE S.PDFIIIIIIIIIIII 4994 709 3RD AVE S ADDRESS: D9 �A 6'9-1S TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS(RECORDED)FOR: CRITICAL AREAS: AJ " �(j�j DETERMINATION: ❑ Conditional Waiver ❑ Study Required M-Miver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DA' PARKING AGREEMENTS DA' EASEMENT(S) RECORDED FOR: PERMITS (OTHER): PLANNING DATA CHECKLIST DA' SCALED PLOT PLAN DATED: - 9 SEWER LID FEE SHORT PLAT FILE: LOT: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: OTHER: LID #: BLOCK: LATEMP\DSTs\Fonns\Street File Checklist.doc APNOTE© BY ENGINEERING BY ENG P4,�b e.0 . tea CITY OF EDMONDS. BUILDING DEPARTMENT . ADDRESS 7P� - S - -� OiNNER . APPROVED DATE. Jj a 6&-D0. OFFICIAL. - PERMIT NUMBER 03 l.(( g= 5 l R too* rV f � I v� s E ►. � —r � � � �.�.b �� pia � RECEIVED APR 2 9 2004 PERMIT COUNTER CITY COPY r APPROVED AS NOTED BY ENGINEERING 14 v Date: — ME CITY OF EDMONDS BUILDING DEPARTMENT WORK G'��¢/ �Gf/1FTTc ADDRESS OWNER APPROVED DATE: BLDG. OFFICIAL PERMIT NUMBER • RECEIVED APR 2 9 2004 PERMIT COUNTER' STREET BILE _ =� driti -a r_eas 1 Ab e . Old"ATA#: 4097-000-002-00 ✓ ti NeW,ATA#: 004097-000-002-00 j New 7 �_== Undo r Fi Exit �. Review Number: CA-2004-0065 Date Received: a 4/29/2004 - -;Applicant: Raugi ° Bldg Number - Street Narne: 3rd - Suffix: AV Dir, S Suite: Int?:❑ Streets: i DetermDate: 5/12/2004 1. Determination: • rWaiver �) Staff Person: Beckley ! `Notes:, ° 3 N• % =�r- " APPLICATION S i F�i E E - 1: 1 L E for The City of Edmonds SIDE SEWER PERMIT NEW CONSTRUCTION [] REPAIRS 0 EASEMENT No . .......................................... 100n Q7 ci On OWNER...... Shorf, .... R.,-.-B .......................... ................................. CONTRACTOR .................................................................................................. PERMIT No . ...................... ADDRESS .... 15.1 .................................... LEGAL DESCRIPTION: LOT No. .............................................. BLOCK No. ............ ............................... I NAME OF ADDITION Jung, Iq 7a Approved:vq, tvsrfed N Se, w c, r-, DATE......................................... : ...... By ...................................................................... DATE RECEIVED `7 PERMIT EXPIRES PERMIT CITY OF EDMONDS ME NUMBER(�iW-�OL CONSTRUCTION PERMIT APPLICATION. JOBs41fE/A1PTi 0 OWNER HAME/NAME OF BUSINESS [} PLAT NAME/SUBDMSION NO. LOT NO. LID NO. T'fA h 0 hall1� A �••� 15 MAILING ADDRESS LID FEE _ O t1 -10 YY 1J 110 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP . TESCP Apaoved: RW IP Ha�trea Street Use Pa mft Ill r/ CITY ZIP ELEPHONE EXISTING PROPOSED S ` ' Q i �� R Q O�U Y` j D RIX) ('LyI O; / ) 1 V REQUIRED DEDICATION FT U. WMg�1NAME' . METER 'SIZE LINE SIZE NO. OF FIXTURES . PillREQUIRED, YES D NO 1 a_ C ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z v ' / t CITY. ' ZIP TELEPHONE NAME CBLp GINEERING REVIEWED BY DATE . cc ADD ES8 I " IRE REVIEWED BY DATE to CITY ZIP TELEPHONE Q VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D 113YEs POSTED ❑NO g SEPA REVIEW SIGN AREA " HEIGHT PROPEl TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED (/V EXP ❑ NEW RESIDENTIAL PLUMBING/MECH ❑ LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS, (Fr.) FRONT SIDE REAR PROPOSED SETBACKS (FT.) FRONT L/R SIDE REAR t7 ADDITION � MMERCIAL ❑ COMPLIANCE OR `❑ CHANGE OF USE _ PARKING LOT AREA PLANNING REVIEWEO,BY : DATE ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REOD PROVIDED s— ❑ 'REPAIR ❑ GRADING CYDS ®. FENCF,� �X i � REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER i GARAGE RETAINING WALL FIRE SPRINKLER ❑ 0 ❑ FIRE ALARM CARPORT ROCKERY C (TYPEOF•tISE,=BUBINES8 R'ACTNffY) EXPTAIN OCCUPANT h a CHECKED BY TYP .'OF CONSTRUCTION CO~ GROUP' ONUMBER OF NUMBER OF DWELLING . CRITICAL AREAS SPECIAL INSPECTI N AREA OCCUPANT et STORIES UNITS NUMBER REQUIRED YES' LOAD DESCRIBE WORK TO BE DONE . REMARKS '.. PROGRESS INSPECTIONS PER UPC 108/FINAL INSPECTION li 9 VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit .�, Gify Surcharge �— PLAN CHECK NO: VELD DATE PluQlbing Base Fee y Mechanical THIS PERMIT AOTHORRES ONLYTHE ORK NOTED. THIS PERMIT COVERS WORK TO I= BE DONE ON PRIVATE PROPEll ONI ANY CONSTRUCTION oN,THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS,'DRn/EWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. • s Engr.. Review PERMIT APPLICATION: 180 DAYS d PERMIT LIMIC 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Ell Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION -APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND BUCCESORS Fire 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 Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE L;;rldSCa a Ills P P Total Amt. Due 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE.. _ . NOR LIMIT IN ANY WAY THE Cli ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee. Receipt ll 1-HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION' APPROVAL 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-.This CALL,:.':. application is not a panne until signed by the TION; AND W DOING THE MfORK:AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYEDBuOding .. 08idel or hb/het Deputy; end:Feea 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 . INSURANCE AND Ill 18.27. SIG URE DATE TLMIE DATE SIGNED " (425) DF� `� /Zq c 771-0220 A EXT 1333: IS TO USE QR'OCCU" A BUILDING OR STRUCTURE UNIT IT .UNUI1wFiL I;� x •.mm�, yaecs cue A- RM NCI M I iIAS B®1 MADE AND APPROVAL OR A CENTi;- CIQE OF40p�ilIM�Y NAS ®- GRANTED.. UBC 8Br m mM � �, � aNi fir.,