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20000200.pdfCITY OF EDMONDS ` CONSTRUCTION PERMIT APPLICATION Mali PERMIT EXPIRE _�RM USE PERMIT ZONE Z_ tC NUMBER JOB ITF)AFT. 3 du, S ADDRESS ob,,t. 1 FLAT NAME/SUBDIVISION NO PT I*, LID NO. 'D FEE I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP r _ p Ahn_d rE -I.—F.I. I.—F.I. - P-4 Rend EXISTING — PROPOSED — ee'. R.n. eld— REGUIREDDEDICATION— FT METEfl 512E LINE S12E NO.OF FI%TURFS PAV REQUIRED .... - - - YES 0 No 0 ADDRESS REMARKSOWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE CRY ZIP ITELEPHONE NAME ENGINEERING REVIEWED/DATE ADDRESS O CITY 21P TELEPHONE FIRE REVIEWED By DATE VARIANCE OR OU SHORELINE OR ADBN !ON D INSPECTION INS '1301�11 . E.0 I GET OYES ONO STATE LICENSE NUMBER EXPIRATION DATE CHECKED13Y SERA REVIEW COMPLETE EXEMPT E p SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED PROPERTY TAX ACCO PROPE �JPROPS TPACELNO. NEW RESIDENTIAL 0 PLUMBING I MEC LOT COVERAGE ALLOWED PROPOSED (Fr REQUIRED SETBACKS ) A FRONT SIDE REAR PROPOSED SETBACKS TTJ BU FRONT RSIDE FEAR COMPLIANCE OR COMMERCIAL 0 ADDITION 0 CHANGEOFUSE PARKING LOT AREA PLANNING REVIEWED By DATE 0 REMODEL 0 APARTMENT 0 SIGN REaD PROVIDED FENCE 0 REPAIR 0 GRADING CYDS 0 1 — — — , " 0 DEMOLISH 0 TANK 0tH— GARAGE 0 RETAININGWALL ❑RENEWAL ROOKERY (TYPE OF USE, BUSIN CTIVITY),EXPLA114-1 1 SS 0 C-,# ce 0 CHECKED BY TYPE CONSTRUCTION.,, 0 'CODE 'C CICGU'�Z UMBER OF 0 STORIES Nu 7ER 014 LiN !.R. NO DWELLING U T' CAL CRITICAL IT CAP-S NUMBER NUMBER SPECIALINSPECTOR RE YES ARE OCCUPANT LOAD DESCRIBE WORK TO BE DONE VALUATION FEE PLAN CHECK FEE HEAT SOURCE GLAZING= LOT 'LOP' I BUILDING PLAN CHECK NO: VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO H BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION, SU CHARGE PE MIT APPLICATION: 100 DAYS PERMIT LIMIT: I YEAR"`PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fg R HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS 'BEHALF So OF ENO. INSPECTION FEE I'APPLICANTET. REST, IN T INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 7TO AGREES 6 ANYAND LANDSCAPING EDMONDS WASHGTON, ITSOFFiCIALS. EMPLOYEES, AND AGENTS FROM ShlGTON, ARISING DIRECTLYOR INDIRECTLY INSPECTION FEE OFWHATEVER NATURE, Of 3 PERMIT SHALL NOT BE Pi POSIT PLAN CHECK DEPOSIT RECEIPT FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF ANY CITY ORDINANCE j DEEMEDTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT ORDINANCE PROVISION' ANY i NOR LIMIT IN ANY WAY THE CITY'S ABILITVTO ENFORCE TOTAL AMOUNT DUE TOTAL ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL I HEREBY I, AUTHORIZED AGENT OF GIVEN IS CORRECT, AND THAT I A. THE OWNER. OR THE DULY CONSTRUC� Thin application I$ let , permit V efil,ighod by the E, U I AGREE To C ITHCI AND STATE LAWS R , LATING OWNER. COMPLY WITH WILL BE EMPLOYED THEAND CALL K Building 011ie I hl,11,�.DlpdIy, 11. Fell — IhnL "I 'im. IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON OF WASHINGTON RELATING TO aceip: is , d in de .,,.Id.d. FOR INSPECTION d_ -- IN VIOLATION OF THE LABOR CODE OF THE STATE WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. OFF NATU SIGNATURE DATE SIGNED (425) lVV I f I .11,144v RELEASED By EXT 333 ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW- INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD - ASSESSOR 5199 z 0. 0 CIA c: ma 0 0 c m m YZ O'n m rn o F 0) 0 z -4 z ii O rv: i ci i +g om j �t co i 1a m Z, on {i mm o v, O� E; Z& 1 Z o' m s/ j>s ATE RECEIVED � � 1r � PERMIT EXPIRES PERMIT CITY OF EDMONDS ZONE S -I Z_ / NUMBER 7_'0 02�k JOB /l/ �1 o%-b /iL' -C- du, ,LTE/A - CONSTRUCTION PERMIT APPLICATION ADDRESS UUii O OWNER NAMEMAME Of QUSINESS PLAT NAMEISt1801VIBI0N N0. T NO, LID NO. UD fEES MAI ING ADDRESS lw ❑ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permi Pqq 1 ❑ Saee1 ilea Permit flegtl ❑ E%ISTING PROPOSED ❑ CITY ZIP TELEPHONE ewelk Paqutree ❑ RECURRED DEDICATION FT aergrauno wlrl�grequvea METER SIZE LINE SIZE NO, FIXTURES PRV REQUIRED NAME VES ❑ NO ❑ - ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROU DRAMAGE i CITY ZIP TELEPHONE lrt NAME ENGINEERING REVIIEMOMATE ADDRESS FIRE REVIEWED BY DATE CITY ZIP TELEPHONE E - VARIANCE OR CU SHORELINE OR ADBp INSPECTION BOND O STATE LICENSE NUMBER EXPIRATION DATE CHECKEDBY REO'D POSTED - 0 _ AYES ❑NO REVIEW SIGN AREA HEIGHT - mSERA COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED PROPERTy3ACCOU TPARCEL NO. 1 ' _ sa�6jid/ .U\V Z-•�' "' _ V EXP ; 1 _n LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) NEW RESIDENTIAL ❑ PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDEREAR G Om -AUDITION COMMERCIAL COMPLIANCE OR ❑ ❑ CHANGE OF USE Z S - mci PARKING LOT AREA PLANNING REVIEWED By ;DATE REC'D PROVIDED �{0,1 ® ❑ REMODEL ❑ APARTMENT ❑ SIGN 0 FENCE ❑ MARS r ❑GRADING REPAIR ❑ CYDS ( _ X FT) Z ❑ DEMOLISH ❑ TANK ❑ OTHER C RETAINING WALL ❑ RENEWAL _ -❑GARAGE ❑ CARPORT _ (TYPE OF USE, BUSINESSO CTIVITY)E%PLAIN: 1 CHECKEDBY TYPE CONSTRUCTION CODE OCCUPAN I{ C P I Ce t� DL (? GROUP ` y, 0 NUMBER OF CRITICAL OCCUPANT .NUMBER pP DWELLING AREAS SPECIAL INSPECTOR ARE / STORIES UNITS NUMBER REQUIRED ❑ Y.— DESCRIBE WORK TO BE DONE REMARKS ROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REQ'D -a 0 Zit _ 1 z VALUATION FEE PLAN CHECK FEE N HEAT SOURCE GtA21NG Y, LOT SLOPE % BUILDING PLAN CHECK NO: VESTED DATE PLUMBING m MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC GRADING/FILL f DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. SU HARGE g PEPMIT APPLICATION: 180 DAYS PERMIT LIMIT.I YEAR- PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION ' ENG. INSPECTION FEE ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND CITY RS IAPPLICANT. HE OF IN INTEREST, AGREES INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF C ING - I N. INSPECTION S EDMONOS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AN AGENTS FROM ANY AND INSPECTION FEE PECTIN .- •--•-• ":- zALL CLAIMS FOR DAMAGESOFWHATEVERNATURE, ARISING OIRECTLV OAINDI FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE FlECEIPT PLAN CHECK DEPOSIT DEEMED TO MODIFY, WAIVE OR REDUCE ANY RECUIREMENTOF ANY CITY ORDINANCE s NOR LIMITIN ANY WAYTHECITY'S ADILITYTOENFORCE ANY ORDINANCE PROVISION: RECEIPT TOTAL AMOUNT DUE .e+•'++ J �•�� / W I HEREBY 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 CONSTRUC- THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUE (,'J,�LI,Buildin0011icinl This epplilM.-is P., a permit uat1l,,g, d by Rho orlrislhor Dopuly: antl Faus nro ppitl. antl TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rccpipl is acknowlatl9atl in spaco providotl. IN VIOLATION OF THE LABOR WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27" OFFICIALS I NATUR r--�, DATE SIGNATURE OWy ORAGENTI DATE SIGNEO �L�;; 3 t l / /'� 'sz) y(425) �TE� I I / I _0220 RELEASED BY ATTENTION EXT 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE • YELLOW -INSPECTOR A FINAL INSPECTION CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER • GOLD- ASSESSOR 519E