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20000634.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEiNAM' OF BUSI ESS To " J , (f w A,>VJ G L- L- MAILING ADDRESS 19720 (ctt'�' PLACL5- CITY ZIP ITELEPHONE � 6 m 6076 1'774-764-!�; NAME ZIP" '/ TELEPHONE LL S I :k.MD I CITY 0 ZIP TELEPHONE 77g -cq'7A- T LICENSENUM EXIIAATI.N DATE STA��EZ ;r, 4R�� 4c'�-col oi�'Tp j ql�; CHEUKLU IT PROPERTY TAX ACCOUNT PARCEL N NEW In'RESIDENTIAL a -PLUMBING I MEER ADDITION M I c COMPLIANCE OR C] COMMERCIAL CHANGE OF USE REMODEL APARTMENT APARTMENT SIGN 2rREPAIR GRADING F NCE — CYDS ( _ X FT) 0 DEMOLISH TANK OTHER RAG E G.A FORT AR RETAINING WALL RENEWAL A RI CKE 0 (TYPEOF ­­Sl,.�SINE��.AACTIIIIY)EXILAIN! 'Y PE OFU S' 0 V" I XPLAIN BU SINESS OR A TI w NUMBER 0 OF STORIES All N BEA OF CRITICAL A A, D ELUNr 13'eVrl ARE Am- N I N S. E W DESCRIBE WORK To E RE TO BE DONE I?c- ri L'i cc 2 A _7_ -1ce w v 'D,,u&:LL4 If I W I 7'x CAlf 0, ki (L e� 944 �'T PERMIT EXPIRES L:- �— USE PERMIT Z0065-14 ZONE NUMBER '0' ADDRESS 'u, Yl PTN r :5A/ PLAT NAMEISUBDIVISION NO. LOT NO, LID NO. LID FEE 5 TESCP App—d 0 PUBLIC RIGHT OF WAY PER OFFICIAL STAEET MAP R_' Se.., Ue P:,.d'.RdI, d 00 EXISTING — PROPOSED— ­­- A-l- 0 0 REQUIRED DEDICATION — d ET 1­1- MET8RSIZE LINE SIZE NO. OF FIXTURES REQUIRED I YPRV so NO 13 FIRE REVIEWED By DATE VARIANCE OR CU HOPEELINE OR ADEN 'No 0 IN PECTtON I BOND SnE 0 1POSTED AEG 0 — 0 YE $EPA REVIEW t SIGN ARE A ll.WEO PH POSED HEIGHT ALLOWED PROPOSED COMPLETE EXEMPT EXP LOT COVERAGE REQUIRED SETBACKS FT.) PROPOSED SETBACKS JM. T UR SIDE REAR LLOWED PROPOSED A LL FRONT SIDE REAR T FRONT PARKING LOT AREA PLANNING REVIEWED By DATE A G PEO'D I PROVIDE. CHECKEDBY I TYPE OF CONSTRUCTION OCCUPANT SPECIAL INSPECTOR JA— LOAD REQUIRED C3 YES REZARK.L—mcorr -TinNs PER UBC 108/1PINAL INSPECTION VALUATION I FEE PLAN CHECK FEE HEAT SOURCE GLAZING % LOT SLOR I BUILDING PLAN CHECK NO: VESTED DATE I U—NG MEC ANhCAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO ONLY. ANY CONST AUCTION ON THE PUBLIC GAADING/FILL GBE DONE ON PRIVATE PROPERTY OMAIN (CURBS, SIDEWALKS, DRIVEWAYS . MARQUEES, ETC,) WILL REQUIRE SEPARATE PERMISSION. STATE SURCHARGE PE MIT APPLICATION: 180 DAYS A WORK IS STARTED WITHIN 180 DAIS ENG. REVIEW FEES YE PERMIT LIMIT'. I AR ' PROVIDED SEE BACK OF PINK PERMIT FOR MORE INFORMATION ENG, INSPECTION FEE ;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIG NSANDS CCESORS NI'Y- DEFEND AND ,OLD HARMLESS THE CITY F LANDSCAPING EREST� AGREES To INDE. CIALS EMPLOY ES, AND AGENTS FROM ANY AND N IN G N�IT OFF' NO WASHIN To S EDMO S. EC LYORINDIRECTI-Y NSPECTION FEE RECEIPT U AAjSjNGD'A R , AT RE.E LA G OF W ATE ER N AT SHALL NOT BE ALL C A DAMA E S ANCE OF THIS PE MIT IMS Fo IS U PLAN CHECK DEPOSIT T U NCE OF THI S PERMIT FROM HE IS A _ I A UC Y RED UIREMENTOF ANY CITY ORDINANCE D To MODIFY IN AVE 0 RED EAN RECEIPT f" BE E ANY OR ILITY To NFORG DINANCE PROVISION NOEME 0 A'I.jT'NANYWAY THE CITY S AB E TOTAL AMOUNT DUE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION APPLICATION APPROVAL I HEREBY ACKNOWLEDGE _ CU 4F CORRECT. AN. THAT I AM THE OWNER. OR TH - LY AUTHORIZED AGENT OF Thl, Appl_,._ he, . h­h u,hl ,19hle by the ehe GIVEN IS THE OWNE 1 A FEE T C MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG CALL Bulldllg 011.c e,hb� Depu,y. Fee, — puld. . NO PERSON WILL BE EMPLOYE ION: AND IN THE ORK AUTHORIZED THEREBY. RELATING TDO FOR INSPECTION �,'d rocoiteiisackn-009 'h be ph—fte. , d I VIOLATI F THE LABOR CODE OF THE STATE OF WASHINGTON 18.27 OFFIC LS SI—ATURE TE RKMEN'S MPENSA I N INSURANCEAND RCVY :3w, e±l— SI NATUR OWNE GENT) AT E s`tA1,,,,' (425) ) 771 -0= ELEASEDW Exl I-di*d ATTE ON IT IS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL 771,=l ------ FILE - YELLOW INSPECTOR NSPECTION HAS BEEN MADE AND APPROVAL OR A GERTI Fl- ORIGINAL - - GOLD -ASSESSOR A FINAL CATE OFIOCCURANCY HAS BEEN GRANTED . UBC SECTION 109 Fn - PINK -OWNER -X� ,,198 77 022 z 0 m —n M M 0 -40 0 0 -4 X M M z 0 E: I 0 -n n m M 0 0 0 9 m 0 z z 0 1 0 m IV, `111� � RECEIVED CITY OF EDMONDSL CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS J. (fHA0WCLL MAILING ADDRESS 872p CIT ZIP TELEPHONE oj-,) 16 o 2- & 7 74 - 7 S4, S7 ZIP / ITELEPHONE Z,5,6611 IMiLLS It CITY ZIP TELEPHONE Z 0 _�TATE —LICENSE NUMBER EXPIRATION DATE CHECKED By .4 LZjj��j� �� jrPROPERTY TAX ACCOUNT PARCEL NO. '3000 6 77-70c)o 00 NEW En-RESMINTIAL 2— PLUMBING/ M CH COMPLIA CE OR ADDITION COMMERCIAL CHANGE OF USE REMODEL APARTMENT SIGN FENCE Y'REPAIR 0 GRADING CYDS 0 1 _ X FT) DEMOLISH TANK OTHER GARAGE RETAIN OVIALL RENEWAL ROC EL 0 CARPORT Y o— ((TYP OF USE. BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMBER OF CRITICAL E AREAS LI.E. OF DWELLING 1,Wrl A AS o STORIES U-1 N Q DESCRIBE WORK TO BE DONE k,)C �L-4* WL� WL( C,.( �g Jc I.,VA-ICA PIPE L."(11 c,,>*,( {--oLL,te, 1-� Qll PERMIT EXPIRES Z_4101 USE PERMIT ZONE NUMBIER 200r034 J05 37ZC> 19IS7_ &/UIT ADDRESS . PI -AT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE S III.—P P -W PUBLIC RIGHT 0 F WAY P ER OFFICIAL STRE ET MAP Fw -F-C 0 EXISTING — PROPOSED - PT REQUIRED DEDICATION FT 0 METER SIZE LINE SIZE N.. .1 FIXTURES F-V PE.U'RE. YES LJ NO .1.1P.—BLE FOR EROSION CONTROUDRAINAGE FIRE REVIEWED By DATE VARIANCE OR CU SHORELINE OR AOB# th 0 SERA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLO W ED PROPOSE 0 I :Xp I — I . — LOT COVERAGE REOUIRED SETBACKS (FO PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE REAR 7—P—ARIX'l.. LOT AREA PLANNING REVIEWED By U­ ED EGO ROVD7 I CHECK50SV7 TYPE OF CONSTRUCTION TAREA SPECIT� �_[�_PECTOR LOAD REOU 0 YES I =RKS ­­ INqPP(.TIONS PER UBC 1081FINAL INSPEI VALUATION I FEE PLAN CHECK FEE HEAT SOURCE GLAZING % LOT SLOPE I BUILDING PLAN CHECK NO: IIESTED DATE PLUMBING MECHANICAL T.M.1 UTHOVIZES Nl THE WORK NOTED, THIS PERMIT COVERS WORK TO It GNP. ATE PROPERTY ONLY. ANY CONISTRUC11C N ON THE P U. LIC �=A RADING1111-1 DOMAIN (CURBS. SIDEWALKS, DRIVE AYS, MASQUEES. ETC.1 WILL REQUIRE :I SEPARATEPEFIM ISSI ON. STATE SURCHARGE PE PIMIT APPLICATION: 180 DAYS PERMIT LIMIT. 1 YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION PLICANT. ON BEHALF OF HIS DR HER SPOUSE� HEIRS. ASSIGNS AND SUCCESORS ENG. INSPECTION FEE ;A N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF FROM ANY AND LANDSCAPING EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS DIRECTLYOR INDIRECTLY INSPECTION FEE RECEIPT ; PERMIT SHALL NOT BE PLAN CHECK DEPOSIT OF ANY CITY ORDINANCE ORDINANCE PROVISION.- TOTAL AMOUNT DUE RECEIPT —1 READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL HEREBY ACKNOWLEDGE THAT I HAVE GIVEN CORRECT, AND THAT I AM THE OWNER, GR THE DULY AUTHOR IZED AGENT OF IS �w �l P by Ih, THCOWNER. I AGREE TO COMPLY WIT. CITY AND STATE LAWS REGULATING CONSTRUC Db��",'�%u d Fbb�.d CALL P .1. ­d. �,,d TtON� AND IN DOING THE WORK AUTHORIZED 'HEREBY. NO PERSON WILL BE EMPLOYED WASHINGTON RELATING TO FOR INSPECTION ­,ipt i� .1k­wIldgld 1. pac. p,­dod, o I VI LATIC I OF THE LA 8 C DE OF THE STATE OF w RKMENS�o PENS INSURANCE AND RCW 18.27, OFFICI LS SIGNATURE AIE AD (425) SI NATUR WNE NT) UP" 771 -Q= ELEASED 17TE EXT W8 TION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771 -TIM FINAL IN PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW INSPECTOR GOLD - ASSESSOR A HAS BEEN GRANTED. UBC SECTION 109 PAR PINK - OWNER CATE OF OCCUPANCY 770/l/ z m m 0 80 c -4 C X M 0 _n .n m M a 0 0 M C 0) 90) M Z :1 -4 :C z z 0 m