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20000739.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION ER NA.FJNAME OF BUSINESS . ZIP ITIL EPHONE CITY, 7 1 1 NAME I )6�F -------- PERMIT EXPIREr,,rdl 14 to I USE PERMIT ZONE NUMBER B SUITEJAPT# ADDRE1,a c Ll i PLAT NAMEIGUBDIVISION NO. LOT No LID NO� I.I. FEE S PUBLIC RIGHT OF WAY PER OF11CIAL STREET MAP P—1 .—I u EXISTING — PROPOSED - REQUIRED DEDICATION— FT — .1 FIXTURES PRV REQUIRED MET.. SqE LI.ESIZE IYES 0 NO 0 =EKIS-11— RESPONSIBLE FOR EROSION CONTROUDRAINAGE FIRE REVIEWED By DATE tP TELE ONE L VARIANCE OR CU SHORELINE OR AOB# --7NS—PECTION RE �D OYES ONO PBOND OSTED 1.�TE STATE LICENSE NUMBER ION d6$QL (,�00 ZZU /Z SERA REVIEW COMPLETE I EXEMPT SIGN AREA ALLOWED I PROPOSED HEIGHT ALL ED I PROPOSED PROPERTY TAX ACCOUNT PAR7,EL NO. E.P LOT COVERAGE REQUIRED SETBACKS (FT1 PF.I.S ED SETBACKS (FT.) 0 NEW RESIDENTIAL I.I.M.WD I EC. ALLOWED PROPOSED FRONT SIDE SEAR FRONT URSIDE REAR 0 IT 0 1 N COMMERCIAL C MPLIANCE OR 0 ANGE OF USE PARKING LOT AREA PLANNING REVIEWED by DATE �]L L V�.DIAI APARTMENT C3 SIGN REO'D PRO VIDED R PENCE GRACING C,GS X FT) REMAHK5 0 DEMOLISH TANK OTHER RAGE C R 0 A AGE GAFl..T RETAINING WALL RENEWAL C] R R=,lNG WALL C3 RENEWAL ACTIVITY, EXPLAIN (TYPE OF USE BUSINESS OR ACTIVITY) EXP IN: CHtCKEDBY pr�ION -Cc.uu-p:R 1� w— ti � --I ICIE -s NUMBER N MBIROF CRITICAL SAS SPECIAIE��N�PE.TOFI A I PANI OF e2 S I STORIES DWELLING UNITS A NUMBER IT REQUI E] YES LOAD E CRIBS WORK TO BE DONE SC D S REZAR�.S... =AR,X—QQ 1-09r.11nims PER UBC 108/FINAL INSPECTION REO PLAN CHECK FEE E GLAZING% LOT —ELOP, BUILDING PLAN CHECK NO: IVESTED DAI�'_ lLU.BI G EC.-ICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Ll BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE G-DIN."'Ll EPUBLIC DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL R OUIRC SEPARATE PERMISSI STATE SURCHARGE PERMIT APPLICATION: 180 DAYS P I PERMIT LIMIT' I YEAR - ROVIDED WORK S STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS ;APPLICANT. N INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE III I I' T.OlFICIAlE,E.11-OlEES,AI,JOAGENTS FROM ANYAND INSPECTION FEE 1 MOND AlH'NOTON LD . AMA E�Cl TEVER NATURE. ARISING DIRECTLY OR INDIRECTLY A LC" &`F . WHA FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT DEEMED TO MODIFY. WAIV OR REDUCE ANY REQUIREMENT OF ANY CITY ORDI ANCE E SI C- N ILITY TO ENFORCE ANY ORDI —CE PROVI OR LIMIT IN ANY WAY THE CITY'S AS TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION GIVEN IS CORRECT AND THAT I AM THE OWNER, On THE DULY AUTHORIZED AGENT 01 THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL PERSON WILL BE EMPLOYED 7ION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO STATE OF WASHINGTON RELATING TO FOR INSPECTI, IN VI LATIO OF THE LAB CODE OF THE WORKMEN S COMPEN ONINS ANCEANDRCWIB.27. (425) x SIGNATURE (OWNS DATE SIGNE ra�� 9- 771-0220 EX11333 ATTENTIOW-/ ITISUNLAWFULTO 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 FAX S- VALUATION I FEE Ai�LICIiTION APPROVAL Tll� -� - . P11- -11 �-gnld by th, Bu,id,.g Olf.—I 11 hl-ll D6F.IY — F— .1. P",E. spaco ProvidodL ....... DATE ORIGINAL FILE YELLOW - INSPECTOR PINK - OWNER COLD - ASSESSOR z mo 0 80 X IS M z 0 -n n x m m a 0 o c: co z --I 0) Z m RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing ...................... Wall.......................... PieriPorch ................. z 'N� Retainirig Wall ........... Slab Insulation .......... PLUMBING: Underground ............. L3 IT Rough -in .......... ?H 0 1 —10 ;i,, 0 0 Commercial Final IT HEATING: ITI Gas Test .................... yv)5 a Gas Piping ............. �;l Equipment ................. 0 Commercial Final M IT EXTERIOR SHEATHING NAILING .......................... 0 FRAMING ........................ C 0, CO FIRST FLOOR FRAMING INSULATION ................... Floor Insulation z Wall Insulation ........... Ceiling Insulation z SHEETROCK NAILING SPECIAL INSPECTION 0 ITI MISCELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY .................. lqEEIVED\ �0 FPERMIT EXPIRES PERMIT CITY OF EDMONDS Z NE -1) CONSTRUCTION PERMIT APPLICATION JOB ADDRESt. L4 + - S� SUITEIAPTI ( K-) OWNER NA IS OF BUSINE S PLAT NAMEISUBDIVISION NO. LOT NO, LID NO. LID FEE S MAILING ADDRESS lis PUBLIC RIGHT OF WAY PER OFFICIALSTREET MAP IEIC p r. P:Al 10 9 L TELEPHONE EXISTING - PROPOSED 0 0 CITY ZIP REOUIRED DEDICATION FT M.TER SIZE LINE SIZE NO, OF FIXTURES PRV R8QUIFED NAME YES [3 NO 0 ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE ADDRESS '_7 0 CITY Epi "P ' T M Id BY FSTATE LICENSE NUMBER El-A.1-- C] NEW 12, RESIDENTIAL M PLUMBING I MECH 0 ADDITION C] COMMERCIAL 0 C MPLANCEOR Go RANGE OF USE DEL �REPAI. 0 APARTMENT 0 SIGN ci GRADING CYDS FENCE 1:1 ( _ X ITI 0 DEMOLISH TANK OTHER 0 a CA ARPORT %ETA�INI.NYGWALL C RENEWAL 1-1-1.1CRACT11ITYIEXPI-AIN; NUMBER NUMBER o F OF D.ELLIN STORIES UNI TS DESCRIBE %WORK TO BE DONE all! FIRE REViEWEDBY DATE VARIANCE OR CU SHORELINE OR ADB# INSPEC ]ON PSOND REGO OSTED OYES 13NO I SERA REVIEW SIGN AREA HEIGHT OMPLETE EXEMPT P ALLOWED PROPOSED ALLOWED PROPOSED -X C p 'Xp , LOT COVERAGE REQUIRED SETBACKS (M. PROPOSED SETBACKS Ir"' ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE BEAR I AR ING P K LOT AREA I PLANNING REVIEWED By DATE JUED VIDEO JUED SEO'D I PRO I.E. CHECKED By TY �PE.I'AIEC ECTOR FROU LOAD R 0 YES OCCUPANT 1081FINAL VALUATION I FEE PLAN CHECK FEE HEATSOURCE "I'll % BUILDING I,ESTED DATE PLAN CHECK NO: PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I.E.1�014E(DN PFRVATE PROPERTY I,ILl. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFiLL 'UR , SIDEWALKS, DRIVEWAYS . MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. L STAT. E SURCHARGE a PER IT APPLICATi N: 180 DAYS M PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENO REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION o I) ON BEHALF OF HIS OR HER SPOUSE, HEIRS. A SSIGNS AND SUCCESOBS �APPLICANT, 5 N INTEREST. AGREES TO :NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF FRO. ANY AND LA DSCAPI FEE 2 EDMONDS. WASHINGTONj TS OFFICIALS. EMPLOYEES. AND AGENTS ALLCLAIMS FOR DAMAGE OFINHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY INSPECTION RECEIPT rROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT DEEMED TOMODIFY. WAIVEOR REDUCE ANY REOURREMENT 01 ANY CITYORDINANCE PROVISION.' FIECEIP I NOR LIMIT IN ANYWAYTHE CITY SABILITYTO ENFORCE ANY ORDINANCE TOTAL AMOUNT DUE I I ?__s , ACKNOWLEDGE THAT I HAVE READ THIS APPUCATIDN� THAT THE INFORMATION APPLICATION APPROVAL I HEREBY GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT or g1ldbythO E LAWS ING Co"'STRU% THEOWNER. IAQRE TO COMPLY WITH CITY AND STATE REGULAT E CALL �,ud.-d-d TION, AND IN Dol RISC, W L EM oy No THE WORK AUTHORIZED THEREBY. NO BE L BREEATPILO To FOR INSPECTION '-P- "- -d0_ P... , d. IN VIOLATIO OF THE LABOR CODE 0 THE STATE 0 F WAS.IN�ToN WORKMEN'S COMPENSATION INSURANCE AND PCW 11,11, FICIALS "GNAT' DATE DATE SIG"EC/' (425) �&_ oD SIGNATURE (OWNER DR AGIN _1 _ 9- I ) " , ,_7_ J.'4 01 1 771-0920 REL ABED BY EXT1333 ATTENTrO977 IT I I UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAt - FILE YELLOW - INSPECTOR A BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR CATE OF OCCUPANCY HAS z j 0 c m rn 0 0 80 c: im m z 10-4 o -n n I m m a z -4 [j) z m " m