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20000642.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION IER NAMEINAMEOF BUSINESS CIT ZIP [) ITEAEP1111 FrA A,= An� q,� 0,9- d a . 0 - NAME CITY ZIP NAME Q) [PERMIT EXPIRES QaN U BE PERMIT 00( ONE NUMBER I)_S6 — Ton SUITE/APT# Vc",%', 1- 11 " � 4 ave. Pi -AT NAME)SUBDIVISION NO. LOT NO. LID NO LID FEE S TIES11APPI-1 PUBLIC RIGHT 0; WAY PER OFFICIAL STREET MAP PYY _ I P R.qd I EXISTING � PROPOSED ­IP".. I =:."�2, Hd U, REQUIRED DEDICATION— FT — Will, FRV REOUIRED YES 0 No Ij RE ­=RK1S­­1.­R RESPONSIBLE FOR EROSION CONTROUDRAINAGE ��A- tk)�fteg Urowf--�-_) I uq-vkl� ENGINEERING ADDRESS 5)n re. E FIRE REVIEWED By DATE p F EP ONE ZL U -51 VARIANCE OR Cu SHORELINE OR ADIM INS STATE LICENSE NUMBER EXPIRATION YES F h �gw W c o i i D-oo b SIGN —AREA HEIGHT I EVEI '.`EMPT SEPI PROPOSED cOMF 'TE ALLOWED 1RoP.EE. ALLOWED PROPERTY TAX ACCOUNT PARGELND. Ow 60 EXP I , LOT COVE AGE REOI -IRED SETBACKS (Fr.) PROPOSED SETBA02"T' PLUMBING I MECH ALLOWED PRoPoSED FRONT SIDE REAR FRONT UP SIDE RE. ADDITION COMPLIANCE OR CHANGE OF USE UOTARIA DATE REMODEL SIGN PARKING jPI_AN11IMG1I1WEWT.­B7_ REQ'D I PROVIDED REPAIR FENCE GRADING cyos X FT) REMARKS DEMOLISH TANK OTHER GARAGE CAR C] BETAININGWALL C3 RENEWAL jTyPFFF�Uo_SRETBUSINESS?1�� . I I .PAP, -NUMBER NUMB 01 A SPECIAILEIDNEPECTOR OCCUPANT OF STORIES DWELLING JNI A- UMBER HEQUIF JAI" L.A. DESCRIBE WORK TO BE DONE REMARKS OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ P,,A-I, IJ 1�� - — /--I- \—y' I r, rxzn Ink 0 VALUATION I FEE PLAN CHECK FEE HEAT CURIO GLAZING I LOT BUILDING PLAN CHEC VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC REQUIRE GRADINGIFILL DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL SEPARATE PERMISSION, STATE SURCHARGE PE MITAPPLICATIGN: 180DAYS PERMIT LIMIT. I YEAR - PROVIDE. WORK IS STARTED WITHIN 18D DAYS SEE BACK OF PINK PERMIT FDA MORE INFORMATION ;APPLICANT. ON BEHALF OF IS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF ENG.INSP TIONFEE LANDSCAPING N INTEREST. 5 MONDS. WASHINGTON ITSOFFICIALS.EMILOYEES. AND AGENTS FROM ANYAND INSPECTION FEE AD OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY MADE BE RECEIPT FLLCLAIMSFORD TOM THE ISSUANCE OF THIS PERMIT. ISSUANCE 01 THIS PERMIT SHALL NOT PLAN CHECK DEPOSIT DEEMED TO MODIFY. WAIIEOR REDUCE AN REOUIREMENT OF ANY CITY ORDINANCE THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- R GEIP NOR LIMIT IN ANYWAY TOTAL AMOUNT DUE REA. THIS APPLICATION. THAT THE INFORMATION APPLICATION APPROVAL I HEREBY ACKNCWLED.E THAT I HAVE GIVEN IS CORRECT. AN. THAT I AM THE OWNER. oATPC DULyRAUT"aF1.1GC ACEINT .1 AND THE OWNER. I AGREE TO COMPLY WITH CITY ST , LAW E.ULAT C.NSTRUC ED CALL 0111-1 P1 -l'. D-Pl'y ­P P.,d. THEREBY, N TION. AND IN DOING THE WORK AUTHORIZE , N WILL BE ENIF CFO PEFSoGTON RE AT'LoYT SUN Nc o ­­1 l �.o — . old � p-9 pl-d- I , FOR INsPECTION IN VIOLATI N OF THE LABOR COD OF THE STATE o WORKMEN .1 COMPENSATION INSURANCE AN.qCW 1827 0 -ICIALS SIGN E DATE SIGNED (425) ------ 771-0220 RE EA ED By DATE EXT 333 ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDIN G OR STRUCTURE UNTIL 771-0221 INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI� ORIGINA_L,FILE - YELLOW. INSPECTOR A FINAL CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK WNER - GOLD -ASSESSOR i z 9 , _:1 0 �n m c: M __10 00 c: m m z ID --I c -Z o -n ,n m M 0 0 0 C cp c ca Z F z z 9 0 m CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS CITY ZIP PIRES USE PERMIT ZONE NUMBER 12Q,-642- JOB SUITUAPT. PLAT NAMEAUBDIVlStON NO. LOT 00, LI NO, I LID FEE I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ­d ;N —I ­­ U.. 1— 0 0 EXISTING — PROPOSED— ­­­ftq.1­ SE.— k R.q."d 0 0 REOUIREDDEDICATION— FT REMARKS OWNERCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ENGINEERINGIV v I %WD/DATE z 54)Cl ci V P. Ij FIRE REVIEWED BY DATE 0 PHONE d 0 �"T4\cmrA S' 9, 4 - STATE LICENSE NUMBER -1-1 — DATE CHECKED BY KED VARIANCE OR C V HIORELINE qR _\_G SMNAREA HEIGHT zii SEPA REVIEW PLETE E.E.vp ALLOWED PROPOSED ALLOWED PROPOSED 45Y PROPERTY TAX ACCOUNT PARCEL NO. , I 0 m c C0 EXP M LL E-- 1 1111AGE ALLO LLOWED PROPOSED IIEOUIAED SETBACKS (Fr. BID FRONT E REAR PROPOSED SETBACKS (FT.) FRONT SIDE REAR UR 0 0 AEW :A z 0 ADDITION R..I. .. I [3 COMPLIANCE OR CHANGE OF USE M 0 REMODEL 0 SIGN PA KING I LOT REGO PR VID D REA PLANNING REVIEW DBY DATE z REPAIR GRADING CVCS [3 FENCE X FTI > r R OTHER DEMOLISH -rANK 'n 00) -n A' G AG RETAINING WALL RENEWAL CARPORT ROOKERY 0 E.P-.: x (TYPE BUSINESS OR ACTIVITYI OF USE HECK" BY PE OF GONSTRU ION CT DE 0 . IT! m IT IC : OCCUPANT �ROUP NUMBER 1. NUMBEFIO' "'IDA AREAS L SPECIAL INSPECTOR Sp CML FE AREA OCCUPANT 0 0 OF 0 STORIES DWELLING UMTS I NUMBER CU'RE REQUIRED [] YES LOAD M cl 2) DESCRIBE WORK TO BE DONE REMA KS M 0 PROGRESS INSPECT IONS PER USC 1081FINAL INSPECTION REQ'D Z _14"Ill z VALUATION FEE z FLAN CHECK FEE 0 0 HEAT SOU GL AZING % RCE LOT SL PE % BUILDING �CHECK NO: [VEST�l 11 PLUMBING JN IT LIT o RIZIS ONLY THE WORK NOTED, THIS PERMIT COVERS WORK Hg " THE PUBLIC tFTHs-pEE.-nA-mNNEA-g ATE PROPERTY ONLY. ANY CONSTRUCTION ON GRADINGIFILL uR . SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.� WILL REQUIRE S SEPARATE PERMISSION. STATE SURCHARGE _PERMITAPPLICATION: ISDDAYS IS STARTED WITHIN ISODAYS PERMITLIMiT.1 YEAR -PROVIDED WORK SEE BACK OF �INK PERMIT FOR,MCR�IN!ORMATION W�'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGN§`AND SUCCESORS tNPINTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAP NG EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND DAMAGESOFWKATEVER NATURE. ARISING DiRECTLYOR INDIRECTLY INSPECTION FEE RECEIPT ALLCLAIMS FOR FROM THE ISSUANCE OF THIS PERMIt ISSUANCE OF THIS PERMIT SHALL NOT 13E PLAN CHECK DEPOSIT D EMED TO MODIFY. WAIVE OR REDUCE ANY REOUJREMENToFANY CITY ORDINANCE - NGA LIMIT IN ANYWAYTHE ILITY TO ENFORCE ANY ORDINANCE PROVISION. TOTAL AMOUNT DUE —P" Y ACKNOWLEDGE THAT I HAVE FIEAOTM.APPUCATION; THAT THE INFORMATION PLICATION APPROVAL IHERE GIVENS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF p—it u,til sg,,d by IhO n THE &AER. I AGREE To COMPLY WITH CITY AND STATE LAWS 91OUITING CONSTRUI, CALL ' 5,,�,n'�Opjjjia�j ,­hEdho, D-Puly: .,d F... .. pid, —d TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ­.ipt i� uk­l�dg.d I, p— F­id-d WO . RKMENS COMPENSATION INSURANCE AND ROW 18.27. DATE SIGNED (425) ! 0 ICV,LS SIG U 7� SIGN ATURE (OW OR AGENT) 1 '14 �R 7 -0220 71 RE EASED B� U.E ATTENTION EXT 333 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- ORiGINAL-FILE YEI-LOW-INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 5198 FAX PINK - OWNER GOLD - ASSESSOR