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20000438.pdf_N DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS rc MAILING A16 RESS CITY ZIP TELEPHONE NAME ADDRESS •Z 2.L�ly �E _�� . _ a CIT ZIP TELEPHONE 5 �d 71 NAME ADDRESS ZIP ITELEPHONE --- r^^ PERMIT EXPIRES USE PERMIT ZONE _ L2 " NUMBER JOB SNITE/APTI ADDRESS Ji l ( � l' AL PLAT NAME'SUBDIVISION NO. 10 NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppIply permn ea p EXISTING i PROPOSED agewuonaatlr ••-1 REQUIRED DEDICATION—��--FT / way �epaaea METER/SIZE �/. fY LINE SIZE 11, NO.OF FIX ES PRV RSCUM YES0 NO .I 4/7 Fb)r- 74,C) FIRE REVIEWED By DATE STATE LICENSE NUMBER "^^""""^" I """"" - - - OYES ONO SERA REVIEW MPLETE EXEMPT j SIGN AREA ALLOWED PROPOSED HEIGHT AlLO ED PROPOS D �✓ /�% I 'ROPERTY TAX ACCOUNT PARCEL NO. J3 ..� - 3 - O�--N - L dRESIDENTIAL PLUMBING!MECHOWED LOT COVERAGE P ._ REQUIRED SETBACKS (FT.) FRONT SIDE REAfl PROPOSED SETBACKS(FT.) FRONT IJR SIDE REAR NEW h COMPLIANCE OR 60 AUDITION ❑ COMMERCIAL ❑ CHANGE OF USE PARKING ❑ REMODEL ❑ APARTMENT ❑ SIGN REQ'D PROVIDED ❑ REPAIR GRADING FENCE ❑ CYDS ❑ ( —� X _— FT) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER ❑ROCKS'GARAGE CARPORT ❑ RETAINING WALL ❑ RENEWAL (TYPE OF ACTIVITY) ACTIVITY) EXPLAIN: TYPI NUMBER NUMBER OF DWEIUNG CRITICAL AREAS rry� �// SPECIAL INSPECTOR OF STORIES UNITS NUMBER REQUIRED ❑YES DESCRIBE WORK TO BE DONE (� (Ai gr 21.r Ll U REMARKS PROGRESS INS, li VIr1/-!li% 1OA17�Cr.E PLAN CHECK FEE HEAT Sp E GLAZING .(= LOT SLOP(' BUILDING PLAN CHE K NO: VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL DOMAIN (CURS% SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. STATE SURCHARGE PERMIT APPLICATION: 180 DAYS A. PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION •APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENO. INSPECTION FEE IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD IT THE CITY OF rnrypplNG i EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANV AND INRP.Et:QQP EE ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY ORINDIRECTLY FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE s NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION: TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING COHSTHUC- CALL THEREBY. NO PERSON EMPLOYED NG TO TION; AND IN DOING THE WORK AUTHVIOLATTION FOR INSPECTII INOF THE LABOR CODEOED OFZTHE STATE OF WASHINGTOINL REBE LATI WORKMEN'S COMPENSATION INSURANCE AND RC W 18.27. SI N RE (OWNEROR'fLGE DATESIGN D (425) T'j 00 171-0220 EXT 333 A ENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 5198 108TINAL VALUATION APPLICATION APPROVAL This appli ,an Is not a pormit until slgnod by nre Building 011iaial or hislhor Dopuly. and Foos — paid, antl roc p- aakn ,dgod In spaco piovd.d. -- FFI ALS SIGNATU4jE-T DATE L ,[ r ORIGINAL FILE YELLOW - INSPECTI PINK - OWNER GOLD - ASSESSOR rt , r . �. /(wN 1 Y �•A,(/i I YY�;(i, ,. ...C� DAIERECEIVED A�JJ .. ' a PERMIT EXPIRESPERMIT 2 CI Y OF EDMONDS ZONE r /,�2 -,- NUMBER { CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTa ADDRESS �} I t .1 ( .,�.., v v (LI V� NAMEMAME OF BUSINESS PLAT NAME/SUBDIVISION NO, LOTN0. LIO N0. . LID FEE 6 WNG ADDRtE - T[SCP Approved OF WAY PER OFFICIAL STREET MAP RW permn Revvxaa O LW1E1_1 PUBLIC RIGHT .-- �,,,_ Sleeet u.e parmn B.pe EXISTING PROPOSED ne ecuon Pepu+ee ZIP TELEPHONE r S-IN Brcwvvxee u — FT \' 'y'/'7� � REQUIRED DEDICATION nn grovvrcee � �M1+1/� MET R IZE LINE SIZE NO. OF FIX ES PRV REOUIR D D NAME r ! II YES Q NO 1 ADDRESS -` REMAR S OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE IC S /,VsprL /,"/S �EL7 D WC.7lJSrc,vC�+n/:',2Ae- CITY ZIP TELEPHONE r NAME A%C :t/y. %fi7UL il{U(> L r✓C. / Sn PYk ,/ % ¢Q ADDRESS ENGINEERING / fREVIE7D/DJg7,E Y y/y 1 i O CITY ZIP TELEPHONE g FIRE REVIEWED BY DATE _ Z O. VARIANCEORCU SHORELINE OR ADBa INSPECTION BOND I. STATE LICENSENUMBEP EXPIRATION DATE CHECKED EY POSTED AYES QNO 0 m j. 'PROPERTY ACCOUNT PARCEL NO. . SEP.A REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT--' ALLOWED' PROPOSED' ALLO ED PROPO D, _ 2 / 3 a-7 - 3 {� - 0 z �� Ub s EXP (n S a LOT COVERAGE REQUIRED SETBACKS (FL) PROP T ED SETEACNS {FT.) FRONT SIDE REAR FflONT LIR/�SIDE REAR �EU! PRESIDENTIAL PLUMBINGIMECH ALLP PO ED Z m COMPLIANCE OR JD [/ n V AUDITION ❑ COMMERCIAL ❑ CHANGE OF USE ✓ PARKING LOT AREA P 1 VIEWED BV DAT y Q C ❑ REMODEL ,, ❑ APARTMENT ❑ SIGN RE O'0 PROVIDED .✓' 2 m l ❑ REPAIR ❑ GRADING CYDS ❑ FENCE X _ FTI REMARKS -.,Z.1 jo ❑ DEMOLISH ❑ TANK ❑ .OTHER Z ❑GARAGE RETAINING WALL ❑ RENEWAL CARPORT ❑allf 03 I. F (TYPE OFU IUSINE)SS OR ACTIVITYI EXPLAIN: CHE K V TYPEOFCONSTNUCTItlN C.q, "- OCCUPANT LV/1\`JF V' GROUP m NUMBER NUMBER OF CRITICAL o OF DWELLING AREAS 0 �'' SPECIAL INSPECTOR AREAc+mfty Ap7•—+ OCCUPANT REQUIRED LOAD =� �Dm STORIES UNITS NUMBER (/1V i it.✓ ❑ YES r O (� DESCRIBE WORK TO BE DONE L� t ,A{ 7 0 ✓ r1 I T dI�-� - 1 �" Se REMARKS T1� Y.j gg�� E",EG'SOSS tomt'''' Z S PER11BC i. PECTION REO'D o O r C y ,/ PROGRESS I S Ili jBAIFIryiA iI r co) roo PA-e_ Z VALUATION FEE vi PLAN CHECK FEE oL V Z HEATS E GLAZING LOT SLOPCJ E,°- BUILDING' �" VESTED DATE 4 PLAN CHE K NO: r` PLUMBING m THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, {H S PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY COT,'L,UCTION,WTHE PUBLIC SIDEWALK,.ORIVEWAYS, MAvpES, ETC)WILL REQUIRE MECHANICAL Ic, GRADING/FILL DOMAIN {CUR05. SEPARATE PERMIS61'ST £SURCHARGE L PERMIT APPLICATION: too D VS j%(,� !'.. PERMIT LIMIT:i YEAR- PROVIDED WORK IS STARTED Vy1T IN 1800 S ENG REVIE)V FEES SEE BACK OF PINK PERMIT FOR MORE INFO hh11 ION - - u' 'APPLICANT, ON BEHALF OF HIS OHER SPOUSE, HEIRS {{IGNS ANO SUCCESORS IN INTES5EST, AGREES TO INDEMR NIFY, DEFEND AND H HA(1MLESS THE CITY OF FROM ANV,AND ENG.INSPECTION FEE T.pppxR}.ppGe �, Ip6pfiCilpµp£E -- 2 EDM0t3DS,WASHIN GTON, ITSOFFI EVLS,EMPLOYEES.ANDAG6666NTS ALLCLAIMSFORDAMAGESOFWHATEVERNATURE. ARISING DIRE LYORIf�WJiECTLY ' z FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PER StThrAI:L1 OT OE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OFANY CTTX� �pNC�E' ANY ORDINANC7'7'YA/1 PLAN CHECK DEPOSIT LWN RECEIPT o_ NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE YN TOTAL AMOUNT DUE V I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATIONi APPLICATION APPROVAL "' GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This epplicallPn is not a pormil until signed by the THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG CALL Building oillcial ar hislhor Dapury: and Fo,,.,,P.,d, and TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED OF THE STATE OF WASHINGTON flELATING TO FOR INSPECTION receipt is ncknowtodgod in space provi IN VIOLATION OF THE LABOfl CODE WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFI ALSSI.NATU DATE „ I SI N Ti1RE (OWNER 0 AGE DATE SIGNED 9 ( �� / g r It fopc - - !) YJ �%U n) 7� I�O6ZO RE EASEDBf DAT A1`TENTION } EXT 333 _ . IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 _-FILE OR ERTIFI- A FINAL INSPECTION HAS OR IGINAL - YELLOW • GOLD-ASSESSOR CATE OFOCCUPANCY H S BEEN GRANTED. UBC SECTION 109 PINK -OWNER FAX sres