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20000863.pdfREC51VED t CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION Vv) PL__ �_ LA, L CITY ZIP _ATELgPHONE POLLQL.=�' 9w —1:1LU'�::'� C— NAME I gu PERMIT EXPIRES =14-2s-01 PERMIT U ONE NUMBER JOB ITEIAPTO ADDRESS 1 J lq;)Yo PL_ FLAT NAMEISUDDIVISION NO. I LOT 00. LID 10. LID FEE S PU 1-10 RIGHT 01 'NAY PER OFFICIAL STREET MAP U 0 ' 0 E ISTING — PROPOSED — SI—I Ulo P.1ok R.od 0 'S'W'P­.� A­W.d 0 _" R—lo'd 0 REQUIRED DEDICATION— FT _­,W.d METERSIZE —]— LINE Sli� NO. OF FIXTURES PRI REQUIRED I YES 0 NO 0 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUORAINAGE ENGINEERING REVIEWEDIDATE ADDRESS FIRE REVIEWED By DATE CITY ZIP TELEPHONE Il VARIANCE OR CU SHORELINE OR ADBo INSPEOPON RED D OYES ONO 1p .. DO STE STATE LICENSE NUMBER EXPIRATION DATE .E.-Y SERA REVIEW COMPLETE EXEMPT SI.N AREA ALLOWED PROPOSED "BIGHT ALLOWED PROPOSED a PROPERTY TAX ACCOUNT PARCEL NO. EXP I I N 0- E.M.NTIAL LUNI.M. I IVEC- EW LOT COVERAGE ALLOWED lF.POBE. REOUIRIDIET ACKSIFTI FRONT SIDBE REAR PROPOSED SITIA KS I FRONT UR SIDE C REA"R COMPLIANCE OR HGE OF USE C] ADDITION [3 COMMERCIAL CHAN EOFUSE CHA REMODEL 0 APARTMENT C3 SIGN ' ON A RK IN G PARKING P P ROV'O" REO'D I PROVIDED PODI LOT ARE __jATE FEN [:] GRADING FENCE . REPAIR CYDS I X FTI I _ X S REMARKS H MA RK E DTH ER DEMOLISH TANK OTHER z PEN EW A L c3 GARAGE C] IRI.ETAINING WALL RENEWAL CARPORT XER 0 r ITYPE OF USE. BUSI CTIVITY) EXPLAIN: A TYPE OF CON!�TRUCTJON 1C 0 OCUPANT GROUP 0 NUMBER OF STORIES NUMBER IF ELL G IN UN TS I ICAL R'TIC L I L"ET P A. A EA AR U.. R NUMBER N E P V'ALE�.NSIECTOR JARIA E L EE .. P REQUIRED Y ES C] YES OCCUPANT LOAD DESCRIBE WORK TO BE DONE RENA... PROGRESS INSPECTIONS PER U.0 IC11311INAL INSPECTION REO'D 2 -Aar-* 0 li len-7 j�&fli hlD D pvi ;vl"_ F7�VA:LUAATII�.N FEE PLAN CHECK FEE "---J- e5l -) I I G-IING % LOT SLOPE % ja SUILUNG aa, �SZr PLAN CHECK NO: IVISTED DATE PLUMBING _0 MECHANICAL - TO THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL DOMAIN (CURBS, SIDEWALKS, DRIVE S, MARQUEES. ETC,) WILL REQUIRdE SEPARATEWPEYRMISSION. L STATE SURCHARGE PE MIT APPLICATI.N: 180 DAYS I PERMIT LIMIT. I YEARRPROVIDED WORK IS STARTED WITHIN 180 DAYS - SEE BACK OF PINK PERMIT FOR MORE INFORMATION o' ;APLICANT. ON BEHALFOF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESOFS P CITY 0 N INTE EST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE R LANDSCAPING EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND ALLCILAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR N N INSPECTIO FEE RE-11T x FROM THE ISSUANCE OF THIS PERMCITAI SSUANCE OF THIS PERMIT SMALL NOT BE PLAN CHECK DEP051T c DEEMED To MODIFY. WAIVE OR REDU NY REoUIREM ENT OF ANY CITY ORDI NANO a NOR LIM IT IN ANY WAY THE CITY'S ABILITY TO E N FORCE ANY ORDINANCE PROVI SI ON.. RE EV,�� 9 X1 TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL GIVEN SCORRECT.A D THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01 NO Tho PP11-1-o 11 o-I . p­o uolil .,Q­ III THEOWNER. I AGREE COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- WILL BE EMPLOYED CALL dloo 011,,ol 11 hl-11 Dlffy�. Foal — Ioo� od TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION �gd rocciPt is acknowladgo p—idocim IN VIOLATION OF THE LABOR WORKMEN'S COMPENSATION INSURANCE AND POW 18,21. ,IALS�IGNATLJ DATE Rt DATE (425) (�� k tta-, ISIGN::Jt!�,OFIAGENT) 771-0220 ele RELEASED BY DATE ATTtNTION EXT1333 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 - YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR z 9 _l 0 m M 0 c M M im, 10 co 0- m M m 0 0 0 Fn C CIO C C/) 0 z C-7 z 9 0 m PERMIT EXPIFiES L PERMIT ND S CITY OF EDMONDS Zo N ZONE NUMBER ,�-n V/ L CAT ON CONSTRUCTION PERMIT APPLICATION 'A`DDRESS 'AOD D ' EBB V_ SUITVAPTN Q_L OWNER NAMF/NAME OF BUSINESS PLAT NAMCISUBDtVISION _6�) LO T NO. L LIO NO, LID FEE S MAILING ADDRESS % q,D Pt- PUBLIC RIGHT 01 WAY PER OFFICIAL STREET MAY UEL HT OF WAY PER OFFICIAL SF P 'C RIG 0 13 00 I �s- t H.H C TY ZIP L62F E.ISTIN. — PROPOSED— No PROPOSE 0 ,,JTELEIHONE -1 Pnu REQUIRED DEDICA�ON— FT 0 nL NO. OF FIXTURES EQUIRED NAME YEPSREV3 No 0 -ADDRESS REMARKS IWI—INTRACTOR RESPONSIBLE _.TRACT.R F _.F. , F P EROSION CONTROIJI)RAMA.E CITY Iii: I rTELEPHONE FIRE REVIEWED By DATE F I E R V E W E D R ' ZIP 'Ty TELEPHONE By 0 VARIANCE OR CU SHOP ELINE OR ADEbf INSPECTION SO V A R iA C E 0 U �U.=EN.E.U..ER POSND EXPIRAT REDID TED ION DATE F.TAI 0 YE, [] NO I S E FE11REW SIGN AREA HEIGHT APLETE EXEMPT ALLOWED PROPOSED ALLO tEO' 'PROPOSED Col M L T E EXEMPT C PROPERTY TAX ACCOUNT PARCEL NO. P EXP EX LOTCOVERAGE REOIJIRED SET ACKI I PROPOSED SETBACKS (FT.) .E L T C VERA_ 0 PLIJ. IN. I-E.11 AILOWE. -.P.EE. FRONT SID5E REA(V FRONT URSIDE REAR W B o C FOP.EEC cl NEW PL"-EING '.EC. A L E C CD-'UAN E OF ci C MPLIANCEOR ADDITION OF USE OF USE CHANGE C3 CHANGE PARKING LOT AREA PLANNING REVIEWED By DATE I J��SEPA REMODEL C] SIGN REQ.D I PROVIDED C] SIGN PENCE P FENCE GRADING AR RE.AH1. X FT) C3 REPAIR 0 CYCR X — FT) 0 TH o OTHER C3 DEMOLISH TANK 20. GARAGE RETAiNII4GWALL C3 RENEWAL CA11101T (TYPE OF US., USINES OR CT VITP EXPI.AIN: CH ECKS.-Y F E OF CONSTRUCTION TYPE OF T T 1111PAN� GFC., __2 NUMBER Nt� NUMB"" SP T_rAF C U N El 1A T OF ..ULING GWI EAS 7,C,,AL_1._NS_pL_T_O HE URE g LOAD MO STORIES :0-T. NU YES E DESCRIES WORK TO BE DONE 111A K' 'K REV R B PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG R SS,.SPE( VALUATION I FEE PLAN CHECK FEE VSeR(CE GLAZING I LOT SLOPE BUILDING I PLAN CHECK NO: JVIEITIO DATE PLUMBIN MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTE.. THIS PERMIT COVERS WORK TO Y BE DONE l.PnIWkTEPRoPERTYDN-AN CONSTRUCTION ON THE PUBLI GRADINGIFILL DRI ARQUEES.ETC.), WILL REGURACE DOMAIN (CURBS, SIDEWALKS, VEWAYS 3 SEPARATE PER�IS`EION. STATE SURCHARGE PE MIT APPLICATION: HWIDAYS ARRPROVIDED ORKISSTA TEDWiT PERMIT LIMIT. I YE W HIN 18D DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION ON BEHALF 01 "IS OR HER SPOUSE. HERS. ASSIGNS All 1U11E111S ;APPLICANT. N NTE EST. AGREES To �NDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF FROM ANY AND I-ANDSCAPIN 2 EDMONPS,WASHINGToN. TS OFFICIALS. EMPLOYEES� AND AGENTS ALLCLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY INSPECTION FEE RECEIPT F ROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT F I ORDINANCE DEEMEDTO MODIFY, WAIVE 0 REDUCE ANY REQUIREMENT 0 ANYCTY PROVISION. 0 NOR LIMIT IN ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE TOTAL AMOUNT DUE THAT HAVE READ THIS APPLICATION; THAT THE INFORM ION APPLICATION APPROVAL I HEREBY ACKNOWLEDGE GIVEN AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CORRECT. AND THAT � Thl, Ippli-tion 11 P11m1t unill 119-d by th, NEk I ACRE To C MPLY WITH CITY No STATE LAWS A EGULATING CONSTRUC- THE OWE o ETHE CALL B,,Id,,g Oft,cial .1 hill- DIPUIY: ,d F­ - P-. TION; AND IN )DING WORKCAoUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED RELATING TO FOR INSPECTION ­,ipj,, .­wI,dg,d in P.co p,ovidod. IN VIOLATION OF THE LABOR DE OF THE STATE OF WASHINGTON DATE WORKMEN'S COMPENSATION INSURANCE AND RCW 18.21. o IALS SIGNATUR J SIGNAGI) IlWNER OR AGE1 NTE s T (425) I,) 17� 771-0220 R LEASED By DATE ArrtNTION EXT1333 L ITISUNLAWFU TO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL L 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORGINAL FILE - YILLO - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER . GOLD - ASSESSOR z 0 0 q 3: M 0 80 c m m z 10--i c > 3: 0 -n n m M 0'. C (a Im z --I x . 1 V5 . . z 0 1 0 m