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20000288.pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION E A NAM ENAME OF BUSINESS 4p—rL rj 5r 0", ING A DRESS Ave- rELEPHONE 11'47 <' ) q � q NAME A CITY 9 NAME zip TELEPHONE a"!� a3 i��v PiP STATE LICENSE NUMBER E ; IR") ON DATE XP BY 171 'SI-Eirs- m 4 0 5 1 eq 91 PROPERTY TAX ACC T PARC L... 3. C3 —�Ew RESI.-TIAL, [3 PLUMB NO I MECH __D A 0 ADDITION ci COMPL ANCE OR CHANGE OF USE REMODEL APARTMENT r-1 SIGN F NICE REPAIR E] GRADING CYDS 0 1 _ X _ FT) DEMOLISH E] TANK r�a OTH&"t o GARAGE RETAINHNGWALL [3 RENEWAL CARPORT SOCKE_ TYPE OF S OR AOTIVITY1 EXII-AIN: NUMBER OF NUMBER 01 / DW LLING CRITICAL AREAS TORIES ;-7 UNITS 3_ MBPR NUMPPR DESCR16E WORK TO BE DONE FPERMIT toh -h EXPIRES USE PERMIT ZONE NUMBER SUITUAPTO ADDRESS If PLAT NAME/SUBDIVISION NO. LOT 10, LIDMO, LID FEE S PUBLIC MIGHT OF WAY PE R OFFICIAL STRS ET MAP TESCP Apl—d " P'.' I :P."ltNdd EXISTING — PROPOSED REOUIRED DEDICATION— FT uno.,,.— PFW REQUIRED YES CI NO 0 RMMARKIS.—T.-T.. RESPONSIBLE FOR EROSION CONTROIJORAINAGE FIRE REVIEWED By DATE gLIES C]NO 'E SERA REVIEW QWlIGN APR�EA. HEIGHT COMPLETE EXEMPT ALL ED POSED ALLOWED , PROPOSED P COVERAGE D P Xp E LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (7.) LOT P RV R ALLOWED ROPOSED FRONT SIDE REAR FRONT UR SIDE PARKING LOT AREA Pl.NIN. REVIEWED BY DATE RSOD I PROVIDED TFUCTIO�N 1p'/ T TYPE O� "" �L.AD CHECKED B;PE '— 7 AREA S ECIALI� -T. REQUIRED o YES REMARKS —rUm9.qq IK19PECTIOMS PER UBC 1081FINAL INSPECTION VALUATION FEE PLAN CHECK FEE � ILI HEATg RICE ING' SLOPE I BUILDING e, 15qT VESTED DATE PLAN CH CK N�. PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO t:I BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTIQN ON THE PUBLIC GRADING�FILL 2 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES. ETC,) WILL REQUIRE z SEPARATE PERMISSION. t: STATE SURCHARGE IT APPLICATIO ; 180 DAYS PERMROVIDED PERMIT LIMIT I YEAR . P WORK Is STARTED WITHIN ISO DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, KEIRS. ASSIGNS AND SUCCESORS ENG. INSPECTION FEE IN "TERES T AGREES To :NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF YAND LANDSCAPING 'I AN ED.oMDE. AEHiM.T.M. TS.F DIALS. EMPLOYEES, AND AGENTS FROM INDIRECTLY INSPECTION FEE ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEIPT FROM THE ISSUANCE OF THIS PERMIT. 9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT 0 ANY CITY ORDINANCE 5 R LIMIT IN ANYWAYTH RDINANCEPROVIStON" NOR LIMIT IN ANYWAY THE CITys ABILITY TO ENFORCE ANY D � TOTALAMOUNTDUE PT -D �5 -D-1 THAT' HAVE READ THIS APPLICATION. THAT THE INFORMATION APPLICATION APPROVAL I HEREBY ACKNOWLEDGE CORME%AND THATPLAM THE OWNER OR THE DULY AUTHORIZED A "T OF p,,,,l ..t,l �,g— by nno GIIINWS - R T�C.. YWITHCITYAND LAWS REGULATING CONSTRUC THE 0 NER I A. STATE CALL ,_, D o'n , b,� ,, :pl ,,, no ol. �d - 71ON IN DOING THE WORK AUTHORIZED THEREBY. No PETS MWILLBEEMPLOYEM : AMD WASHIoNGTON RELATING TO U,�,n p—A.P FOR INSPECTION I N VIOLATION OF THE LABOR CODE OF THE STATE OF WORKMEVECoMPENSATION INSURANCE AND RCW 18 27. OFFICIALS SI NATURE DATE SIGNATURE (OWNER OR DATE SI NED (425) //#/ Z x-- ....... 00 1 771-0220 DAT E FtELE E EXT 333 ZE ATTENTION G OR STRUCTURE UNTIL IT IS UNLAWFUL TO USE OR OCCUPY A BUILDIN 771-0221 INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI, o IGINAL FILE ASSESSOR A FINAL BEEN GRANTED. UBC SECTION 109 FAX PINK OWNER GOLD CATE OF OCCUPANCY HAS Z a m c C3 fn 0 0 C X M M Z 0 -n A M III 0 0 c: co m (j) m 0 Z .1� ;0 Z CA Z 9 0 m RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS FOUNbAnt).N:,, Footing ...................... Wall Pier/Powh ................. t z 0 Retainirfg Wall j Slab insulation .......... o PLUMBING: Underground ............. a rn Rough -In ITI 0 0 Commercial Final HEATING: IT, Gas Test . . ......... Gas Piping ............... Equipment . .......... commercial Final EXTERIOR SHEATHING NAILING .......................... 0 C FRAMING .............. FIRST FLOOR FRAMING INSULATION ................... Insulation Floor Wall Insulation ........... Calling Insulation SHEETROCK NAILING Z� SPECIAL INSPECTION M MISCELLANEOUS .......... ----- FINAL APPROVAL FOR OCCUPANCY .................. YP7�i RECEIVE. I 11I,�. LPER�M[:T �EXPIES �D- us CITY OF EDMONDS zo PERMIT NUMBER SUITEIAPTN (A) CONSTRUCTION PERMIT APPLICATION JOB ADD/E OWNER NAMEINAME OF DUBIN t I T­ OA PLAT NAMEISUBDIVISION NO. LOT NO, LiD No. 11. FEE S MAILING ADDRESS 4_t� '�L 3 )w 6 PUBLIC RIGHT OF WAY PER .1liCill- STREET MAP EXISTING— PROPOSED— REQUIRED DEDICATION— FT — TESCP Ap­d 0 BW I—, P­�,.d u .,­IU..P­R Id . ­­.� A tix 0 ­­ P. d U�':=­ CITY ZIP .2� IT ELEPHONE 0 OF FIXTURES P REQUIRED YES 0 NO 0 NAME ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE JCITY'J"jC'fVti_S, J'i ZIP TE7 I _�. q 4 NAME AENGINEERING REVIi ADORE.p z FIRE REVIEWED BY DATE c Zip 0 V L�)k t TELEPHONE - 0 m 55 m c lTI 00 0 m m z VARIANCE OR CU SHORELINE OR ADBtI INSPECTION Q ES M C3YRE 'D NO IPIOND OSTED STATE LICEN I NUMBER (y) 0 I Sir S 'N �RSA SEPA REVIEW PE E E EMIT ALLOWED PROPOSED T -P VE HEIGHT ALLOWED PROPOSED PROPERTY TAX ACC T PARC EL NO. NEW PLUMBING I MECH C MPLIANCE OR ADDITION CID HANGE OF USE C] REMODEL SIGN R BE ED SETBACKS I".) LOT COV� LOT C VERAGE ALLOWED PROPOSED FRONT SIDE BEAR PROPOSED SETBACKS (l) FRONT UR SIDE BEAR REGO I PROVIDED NNING REVIEWED By �AT. 0 GRADING GYCS 0 FENCE REPAIR X FTI Xs . EM S jt�ev 0 DEMOLISH (3 TANK OTH "VZ I pj oGARAGE C3 RETAl'N'lNGWAll 0 CARPORT R CK RENEWAL o n -n rn M (TYPEOF Si NESS OR ACTIVITY) EXPI-AIN: CHECKED ly ITY11 OF CqSTnjON I LE CCUPANT Di I r ) F) 0 5 o Fn C 0) 9 (4) m z 0 NUMBER OF o STORIES 2— N DER F ELLIN 0 U TS CRITICAL AREAS NUMBER 1PE1111-111i JAREA REQUIRED n YES LILA�.UPANT` DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 11081 INSPECTION REO'D it > z 3: VALUATION FEE 0) z PLAN CHECK FEE 0 HEA�J�E OT SLOPE % BUILDING 0 m PLAN CHFCK N� STED DATE PLUMBING 3tl. MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DAo'Nl'oN PRIVATI PR.PEBll NLl. ANY CONSTRUCTION 0. THE PUBLIC GRADINGI ,.EWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE CUR . S SEPARATE PERMISSION. _T b: TATE SURCHARGE PEB.ITAPPLICATI N; 1180DAYS PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INrORMATION ENG. INSPECTION PEE SSiGNS AND SUCCESORS ;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. A M ANY AND N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING M EDMONDS, WASHING N, ITS OFFICIALS. EMPLOYEEgj�ANDIAGENTS FRO INSPECTION FEE ALL CLAIMS FOR DAMTOGES OF WHATEVER NATURE. A IN R­ - OR 14-11.­ _. RECEIPT '7 m FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT $HALL NOT BE PLAN CHECK DEPOSIT DEEMEDTOMODIFY, WAIVE OR REDUCEANY REQUIREMENT 0, ANY CITY ORDINANCE T= NOR LIMIT IN ANYWAY THE CITY'S ABILITYTO ENFORCE ANY ORDINA RECEIPT TOTAL AMOUNT DUE �5 D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL GIVEN CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF Thl� ­ , pe—ft ,W �Iglld by III, IS E CALL BWd.119 0111-1-101 bt-AIIII D- ... ... ... THEOWNER, IAGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOY ED Pttty� -d'd IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION llklmlldg d I tip"A It — WORKMEN S COMPENSATION INSURANCE AND RCW 19,27. OFFICIALS SIGNATURE DAI E ATE SIGNED (425) SIGNATURE JOWNERORAGEI / L���' 771-0220 :jEi DATE ATTENTION EXT 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTUREUNTIL 771-0221 PECTOR A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- PINK - OWNER - GOLD -ASSESSOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX S"I't