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20000882.pdf
0 41ui` *ATE RECEIVED jqG o -Ine PERMIT EXPIRES . CITY OFEDMONDS ZONE PERMIT r �, �jl; NUMBER CONSTRUCTION PERMIT APPLICATION 2ZE�ER NAME/NAME OF BUSINESS `Oew>C o ADZ-lL+c� l l U,1C, kilt" MAILING ADDRESSt 34144 �.� � kA 74 CITY ZIP TELEPHONE qBIqo*5bq 200 InL. 22J., WA NAME ADDRESS CITY ZIP TELEPHONE ADDRESS wj rw CITY vVW CJg4�P' TELEPHONE r LQJ STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY PROPERTY TAX ACCOUNT PARCEL NO. L ,OoO.otO. orjp3 ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING•/ MECH ADDITION COMMERCIAL❑ COMPLIANCE OR ❑ �. CHANGE OF USE ❑ REMODEL ❑ APARTMENT ❑ SIGN ❑ REPAIR GRADING CYDS C1ENCE X FT) ❑ DEMOLISH ❑ TANK T �R , -A E3 GARAGE G WALL ❑ RETAINING ❑. 'L ROCKERY RENEWAL (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: �— L NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS 1. NUMBER DESCRIBE WORK TO BE DONE JOB ADDRESS �/ O b �ti PLAT NAME/SUBDIVISION NO. LOT NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING PROPOSED REQUIRED DEDICATIONFT METER Zif 11 Ulm.6i�,i NNQFU&r OWNER/CONTRACTOR E/APT# LID NO. LID FEE S TESCP Approved ❑ RW Permit Required ❑ Sheet Use Permit Req'd ❑ Inspection Required ❑ Sidewalk Required ❑ Underground Wiring requited ❑ PR.V REQUIRED 0 YES ❑ NO ❑ Z w z z UDRAINAGE a z w J ENGINEERING REVIEWED/DATE I 1 tVIEOE DATE w Z + �o %/� U. 0 VARIAN OR CU SHORELINE OR ADB# INSPECTION BOND m I ` ❑ S g _ POSTED p'+ YES NO SEPA REVIEW . SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED _ EXP I O M LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ! m 0 ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7 O z n z O C PARKING LOT AREA PLANNING REVIEWED BY DATE g = m REQ 'D PROVIDED 10 REMARKS CZ r_ -1 O � CHECKED BY TYPE CONSTRUCTION COLOg OCCUPANT GROUP rn m SPECIAL INSPECTOR AREA OCCUPANT 0 REQUIRED ❑ YES LOAD Q r M REMARKSz rb 0) PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D S t M n 'm -Zi D �W OMNI2 Z 1 � VALUATION FEE 0) PLAN CHECK FEE Z 0 HEAT.SOURCE GLAZING % LOT SLOPE % BUILDING { n M PLAN CtigCK 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 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADING/FILL F SEPARATE PERMISSION. i STATE SURCHARGE S� PERMIT APPLICATION: 180 DAYS ILL! a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION N ".APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE N w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND . I OWTEE ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY RECEIPT = FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE PLAN CHECK DEPOSIT' ✓ J i NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." R CELPT • TOTAL AMOUNT DUE . y I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by Tho TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011ictal or his/her Deputy' and Foos aro paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. I WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OMICIGYNE DATE SIGNATU (OWNER OfAGE T DATE SIGNED (425) © lr�+� O 771-0220 RELEASED BY DATE`--ll.J� ATTENTION EXT1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL '771 0221 G / ✓�� /` '' A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR 1 , CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR Is 5/99