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20000180.pdf---i " DAT'R­ILL� rp 7ER7m iIT E x P �lg E s ' ' - US PERMIT 1200180 CITY OF EDMONDS ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JOB ADDRESS �� SUITVAPTI * ER NAMENAME OF BUSINESS TV - P— NAM111USDIVISION NO. LOT NO, NO, A F— o rZ 15 M 7- S - I Il I LID FEE $ MAP r 0 '1��GDRESS e P SLIC RIGHT OF WAY PER OFFICIAL STREET A 0 0 EXISTING— PROPOSED— R­­ 0 S.— R_­ CITY ZIP JTELEPIIO�E 2_D FE.UlSED.EDICATION— FT NAME ES PRV REOUIRED YES 0 NO C3 ADDIES/ REMARKS WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDSAINAGS CITY ZIP TELEPHONE NAME 6 Iz 1vVC-tt_ E PZE f P,7c—�--nf E'S'NG ENGINEERING EN IN G ADORES$ 1. t5 A4V L �jl DATE ZIP I CtTje��/Vr TE 3 TELEPHONE 2-.-,3 RE E EWE BY REVIEWED By FIRE V 4,g c23 W --, 27- 6 11 S7 _Z2 6 BOND -5 E TE V r .0 VARIANCE OR CU A A" E SHORELINE OR ADEN INSPECTION POSTED STATS LICENSE NUMBER 0 YRE010 es 1 .0 /V Fro SEPA REVIEW C I'M S"PA R� VIEW E EXEMPT OMPLETE EXEMPT PLL SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROFOSED Rm )u EXP EXP I , RESIDENTIAL 0 PLUMBING I MECH COVERAGE LOT OOVEFAGS LOT ALLOWED PROPOSED LLOW PR.POE REQUIRED SETBACKS (FT) FRONT SIDE REAR PROPOSED SETBACK$ (FT. FRONT UPSIDE SEAR Ew OR 0 C OMMEACIAL n COMPLIA CE OR CHANGE OF USE REVIEWS. .1 DATE C3 REMODEL /_ . f-I APARTMENT 0 SIGN REOD :::,Aj.KpN. �P-.NIZ n F NCE 0 REPAIR 0 GRACING CYDS (C_ X _ FT) REMARK - DEMOLISH C3 TANK Lai ll��N,Nyll WALL 0 RENEWAL o GARAGE C] CARPORT P E -7— USE, SUSINESS ACTIVIT:IPL N N Go OPUS TYPE OF CHECKED By TY WOF CONST ION G.QlPA6 'S. P NUMBER NUMBEROF C ITICAL AREAS SPECIALINSPEC OR AREA OCCUPANT LOAD G, OF DWELLING UIN­ JDESRIBE NUMBER REOUIRSD C] YES STORIE C N, WORK TO BE DW S' RK MA A a t GRESS INSPEcTioNs PER UBC 108IF-N WIDE PRO —111 VALUATION FEE PLAN CHECK FEE HEAT SOURCE LOT SLOPE I BUILDING PLAN CHECK NO: PLUMBING ECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADiNGIRLL 5 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS' MARQUEES. ETC.) WILL REQUIRE :1 I SEPARATE PERMISSION. STATE SURCHARGE PERMIT APPLICATION: 180 DAYS PERMIT LIMIT. I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS ENO REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION ENG. INSPECTION FEE 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO:NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF E NDS.WASHINGTON , TS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND DMO AGE OF WHATEVER NATURE, ARISING O'BECTLYOR INDIRECTLY INSPECTION FEE REC51PT ALLCL�JMSFORDAM FROM THE ISSUANCE OF THIS PERMIr. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT DEEMED TOMOCHFY. WAIVE OR PSGUCSANY REQUIREM15NT OF ANY CITY ORDINANCE CITTS ABILITY TO ENFORCE ANYORDINANCE PROVISION.- RECEIPT 0 NOR LIMIT IN ANY WAYTHE TO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIULN� THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORR H TAM THE OWN"' R T' 0 AUTHORIZED AGENT 01 ECT,ANO T.A OT PSGUI-ATING CONSTRUC- THE OWNER IAG. T. C pLy WIT. CITY AN6 S ATEELAW. 'u"T I-PPIM n-t u"I I'9�'d "Y I" ding Offin,111 11 hl,lh,, Olplly: I'd F001 "I PIld Ind TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERS N WILL BE EMPLOYED THE STATE OF WASHINOGTON RELATING TO F TION ­,q, ­I,­lldQId­pIwp­d,d, IN VIOLATION OF THE LABOR CODE OF WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. — (425) OrFj AL NAT SIGNr�(Ow R SAO L I DATE SIGNED __ 771-0220 R A By -WftENTION EXT333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 - —ORIGINAL-FILE FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- - YELLO�,-'I'N'S'P,�.C.TOR� 3 A CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX 5198 IF ECT APPROVAL EDEM INAL PROU 2800 TO: DEVE if� r, h� CT81. 0�6 -DATE: M[EMO TO: PERMIT coolzDiNATOI;� BUILDING DIVISION FROM: E �---�_FIRE DEPARTMENT DAT G DIVISION DATE LANNING DIVISION DATE— PROJEC SITE ADDRESS PERM[IT4_2::. �00�.ADB#_________J)ATE INSPECTED, —(Q 0 DESCRIPTION OF WORK TO BE INSPECTED_E�&�-- A field inspection was conducted to determine compliance with approved plans. Final approval denotes that there are no objections from the above signed Department to the granting of: in.1 approval ofthe described work erformance Bonds associated with the project may be released GRANT FINAL PROJECT APPROVAL 37;�1-761/ 6k GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED e(-- YAILED FINAL INSPECTION - OUTSTANDING ISSUES 2. 3. RE_]NSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL ocaprvl.doc,l:temp:bldg:forms6/98 z 9 0 C M MO --1 0 0 0 M M Mz jo C cn o -n i x M 0 0 0 C cl) C Cn M 0 Z F- z C/) z 9 0 M RECORD OF IN§PECTIONS, — --- - ---------- --- 7- v, ATE RGC51 Fp ERMIT EXPIRES PERMIT t?_ocql60 CITY OF EDMONDS ��NE NUMBER CONSTRUCTION PERMIT APPLICATION JOB ADDRESS SUITIMPTI V OWNER NAME)NAME OF BUSINESS PI -AT NAME/SUBDIV.- - RES$ MAILING ADDRESS ay LID FEE F WAY PER OFFICIAL STSEET MAP T-1 A-1- C, EXISTING - PROPOSED 0 5­1� A., CITY ITILIPH6NE PEOUIREDDEOICATION_ FT PRY REQUIRED METER SIZE LINE SIZE NO. OF FIXTURES YES 0 NO 0 ADDRESS REMIARNS.-TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE FT-y_ ZIP ITILIP110hiE JAME �l 12 1 /V ENGINEERING WDRESS 17-1 g- FIRE REVIEWED BY DATE ? T Z1, �IT�6".r4g( ___F_� T -3 T5 g VAR ANCE OR CU S .. ELME S A.U- INSPECTION BOND AEOID IPOSTED C3 YES C3 NO I PUATION DATE D a COMPLETE I EXEMPT p SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED , PROPOSED IRO A IQ rC T P( jQrCjQrC NQ CX4 jQrC Ew RESIDENTIAL [3 PLUMBING MECH 4- C MPLIANCE OR A=11.- Go HANGEOFUSE �C] REMODEL APARTMENT 0 SIGN GRAM FENCE X FT) REPAIR cl NO CYQS x 0 'DEMOLISH TANK HER ARP Cl RMINYG WALL RENEWAL oG AOG�ET CAR L T COVERAGE o ALLOWED 'PROPOSED REQUIRED SETBACKS JFT) FRONT SIDE REAR PROPOSED SETBACKS (FT.) FRONT UP SIDE nEAR 0 z PARKING REQD I PROVDED LOTAREA P�NMNGSEVIEWEDBY DATE REMARKS (TYPE OF USE. BUSINES;fl� CHECKEDBY ITY OF CONST $ON 1 co -UM -S �',U,=--��D ML'� T.R,S UNITS CRITICAL AS NUEMASSEI SPECIALINSPEC OR REQUIRED 0 YES AREA OCCU ANT LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REOT; Ann '�Y)( F1 VALUASON I FEE z 0 c m M C7 , I 0 m J 7. PLAN CHECK FEE z 9 HEAT SOURCE GLAZING % LOT SLOPE % BUILDING 0 PLAN CHECK NO: ESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVE RSWORKTO BE DONE ON PRIVATE PROPERTY ONLt ANY CONSTRUCTION ON THEPUB C GRADJNGIFILL DOMAIN (CURBS, SIDEWALK% DRIVE MA UEES, ETQ) WU,%EQUlRE, SEPARATIEWSYRS!'ISS1,0,0N. PE MIT APPLICATION; 160 DAYS S PERMIT LIMIT: I YEAR PROVIOEOW RK IS STARTED WITHIN ISODAYS ENG. REVIEW FEES SEE BACK O� PINK PERMITOOR MORE INFORMATION -APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS NOSUCCESORS ENG. INSPECTION FEE IN INTEREST. AGREES TO I ND5MNIFY, DEFEND AND HOLD HARMLESS THE CITY Or L NOSCAPING i, eomoNoS WASHINGTON OFFICIALS, EMPLOYEES, AND AGENTS FROM AN' AND DIRECTLY OR INDIRECTLY INSPECTION FEE I ��L A, SFOSUANAGEilTS OFWHATEVER NATURE� ARISING gl___ OF THIS PERMIT. ISSUANCEOFTHISP RMITSHALLNOTSE PLAN CHECK DEPOSIT RECEIPT F ANY CITY ORDINANCE ADINANCE PROVIStON.� TOTAL AMOUNT DUE RECEIPT t HEREBY ACKNOWLEDGE THAT I HAVE RSAD THIS APPLICATION' THAT THE INF RMATJON APPLICATION APPROVAL GIVEN I CORRECT. AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF Thl,I '� - " P-I-IJ �i3O by - THE OWSER, I SEE TO COMPLY WITH CITY AN6 STATE LAWS REGULATING CONSTRUC EMPLOYED CALL Bl,ldllg Offill't 11 'i'MOt DO,ull: -d F­ ­ P-'�. -�d SON, AND IN DOING TH WORK AUTHORIZED THSETATEBY�NO PE ON WILL BE ELABOR DOE 0 THE E RS GTON RELATING TO C ' WASHIN ­ FOR INSPECTION pd­­.p­,d.d. 'd ­­0p,-d.d. IN VtOLAT ON Or THE I WORKMEN'S COMPENSATION INSUSANGg AND SCW 18,27. OFFIC AL NAT TE B'. 0,, (425) 771-0220 1 By D AffENTION EXT 333 TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 IT IS UNLAWFUL INSPECTION HAS BEEN MADE AND APPROVAL OR A IERTIFI. ORIGIN�L RLE - Y LOW - INSPECTOR A FINAL CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK � OWNER - GOLD - ASSESSOR