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20000886.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAM11MAIll 01 BUS NESS 11 MAILING ADDRESS CITY ZI ITELEP"ON' C),Z L4D,,5 1W P ,p TELEPHONE .I ADORE S PERMIT EXPIRES - _21 17/ D US5 PERMIT IDNE �p NUMBER _()6686 J'O 8 ITVAPTO '� D D R E S 5 � �5 —1 � t JA PI -AT NAMEISUBDIVISI.. NO. I LOT 10. LIDIO* LID !EE S PUBLIC RIGHT OF WAY PER OPFICIAL STREET MAP I UP Alpl— EXISTING — PROPOSED— REGUIRED DEDICATION— FT V REaUIRID lEps 13 No cl T .. T.R RESPONSIBLE FOR EROSION CONTROUDRAINAGE FIRE RGVIEWEDBY DATE ;ITY ilp PHONE ITEL LA`,5-3 RCU SHORELINE OR AOBk I N SR�E.07.10 N NO E.,—I ION DATE CHrED BY VARIANCE I PI 00 STE. 3TATE LICENSE NUMBER [3YES QN0 SIGN AREA HEIGHT ALI.OWED PF OPOSED BEIA REVIEW ROPERTY TAX ACCOUNT PAFCBL4 7 COMPLETE EXEMPT I ALLOWED PROPOSED I cI� 9; \ CO 00 Io EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PR D SETBACKS (FT) ;t_NEW RESIDENTIAL PLUMBING I ME.- A-.-E. PP.PO.E. FRONT E1.1 REAR FRONT UR SIDE REAR C MPLIANCE OR ADDITION C3 COMMERCIAL OF USE C] CHANGE PARKING LOT AREA PLANNING REVIEWED By DATE C] REMODEL APARTMENT SIGN REDD I PROVIDED FENCE X FT) 0 REPAIR GRADING CYOS x FT) MARKS C3 DEMOLISH C] TANK OTHER CA'AGE C] R MIN WALL 0 RENEWAL 6 Rl.FT lIyG CA 3MF - CHECKED BY E OF CONST N PAN C DE OGROUP NUMBER NUMBIROF 'TCAL SPECIAL INSPECTOR AREA OCCUPANT OF I G DWELL N I EA. I REQUIRED YES LOAD STORIES UNI TS 0 DESCRIBE WORK TO BE DONE KS REMAq6 RIESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO =_Z 2- , m\s`IA 0 f VALUATION FEE PLAN CHECK FEE AT S URCE GLAZING I LOT SLOPE % BUILDING I I PLA ECK NO: IVES71D DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER5WUHI ON THE PUBLIC 'EDON' ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION DRIVEWAYS, MAR.UEES. ETC�l WILL RECIUIRE GRADINGIFILL M A1.11, M DOMAIN (CURBS. SIDEW SEPARATE PERMISSION- URCHARGE PERMITAPPLICATI.N: 10DAYS PERMIT LIMIT. I AR IV'DED Wo" S STARTED WITHIN 180 DAYS YE P K, ' R' ENO. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION ASSIGNS AND SUCCESORS HERSLD A CE H ..L THE CITY F ;NAP,PNLT'ECRA�OST�.OAN.O.'�H.A�LFTOO',NH.'��..��,,�y�F SPE��,SE NO .0 ENG. INSPECTION FEE LANDSCAPING WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS PROM ANYAND INSPECTION FEE 5 EDMONDS. ALLCLAIMS FOR DAMAGES OFWHATEVER NATURE. ARI"N' ""ER RECEIPT FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE 0 F THIS P CITY ORDINA CE PLAN CHECK DEPOSTT MODIFY.WAIVE OR REDUCE ANY REQUIREMENT OF ANY DEEMEOT PRO ISI.N.- ANY ORDINANCE PRO RECEIPT 4;& 0 NOR LIMIT ION ANY WAY THE CITY'S ABILITY TO ENFORCE THI S APPLICATION; THAT THE IN FORMATION A PLIC ION APPROVAL '"ERIBY LE DOE THAT: HAVTE READ UTH A. HE OWNER. OR THE DULY A ORIZED AGENT 01 ,-pp, n., �,g­ b, ft T '-IF..-. HEN S=T.AN.T.A, C.NSTRUC- C TAE T 0 INER, I A131EE 1. C.-Il WITH CITY AN �T EMPLOYED Bulld,19 011i,lal 11 hl�lhll OOPU P.K� �d NWSFEG��LATING TION, AND,IN DOING THE WORK AUTHORIZED THERE By 0 PE �. WL BE WA HI�. ON RELATING TO d TION -,,I I� gld 5pace Pro,,Idodq IN VIOLAT ON OF THE LABOR CODE 0 TH . STA , OF AND RCW 18. T WORK.ENS COMPENSATI URANCE (425) 0 DATE SIGNED WHER AGE L— "'? �) 1 I f 1 .4v BAT E EXT 333 ATTENTION IT IS UNLAWFULTO 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, U13C SECTION 109 FAX PINK -OWNER GOLD ASSESSOR 5MS z M am a m 0 80 a � c A M 0 0 _111 m m a I 0 C 90) , M 0 z :-I z --I z 9 0 m , M CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION MAILING AODREIS '� U 'R y v� -1 ,1- � I — CITY ZIP TELEPHONE LIA-5- 4A\5 ZIP lip TELEPHONE M-lL­k (o 3 � I U/� cK— PROPERTY TAX ACCOUNT PARCEL NO. inn Q; 1� 00 Or) IC) 3&NEW )§ RESIDENTIAL PILL..'.. I M.C. 0 ADDITION C3 COMMERCIAL C MPLIANCEOR CHANGE OF USE C] REMODEL C3 APARTMENT [:J- SIG. C] REPAIR Ei GRADING C,DS (FENCE X FT) 0 DEMOLISH TANK OTHER G R CARPORT 'ETAlNl.N'G WALL CC 0 RENEWAL ESS OR ACTIVITY) EXPLAIN: NUMBER NUMBE1.1OF "I"'AL �AAEAS OF WEL' UNIT. NUMBER _STORIES DESCRIBE WORK TO BE DONE 41 PERMIT EXPIRES USE PERMIT 'ONE K-S 42 NUMBER :ZIDI)t86v JOB ITEAPTP ADDRESS PL PILAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE S T­:App..d PUBLIC RIGHTOF WAY PER OFFICIAL STREET MAI M 0 0 0 EXISTING — PROPOSED— 0 cl PEOUIRIED DEDICATION— FT — WIft, 1­1­ METER SIZE I LINE SIZE I NO, OF FIXTURES I PR.V REQUI.REO Y. N REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE FIRE REVIEWED BY D E VARIANCE OR CU SHORELINE OR ADD. INSPE ION RE PBO D OSTEC OYES C]NO REVIEW SIGN AREA COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED :9P I I I LOT COVERAGE REQUIRED SETBACKS U`T ) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UP SIDE REAR PLANNING R EV'EWED BY DATE EOpARKpN';Vi -ED REMARKS rCHECKED BY PE OF CONST J' P J'N _ff�_5PAN ;rz_ SPECIAL INSPECTOR AREA PANT REou RED [] YES REMARKS P p 0. .Sp..To ROGRE.. INSPECTIONS I ER UBC 10131FINAL INSPECTION REO'D I VALUATION FEE LAN CHECK FEE �WE BUILDING PLUMBING PLAR CHECK NO: MECHANICAL THIS PERMIT AITHO IZ16 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BEDONEONPRIVATEPA PERTY ONLY. ANY CONSTRUCT[ NONTHEPUBLIC GRADING/FILL L.S. DRIVE 5, MAR.UEE., ETC.� WILL E.UIRE DOMAIN (CURBS. SIDEWA WAY SEPARATE PERMISSION PERMIT APPLICATI N: 1.0 DAYS PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION -AP PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCSSORS ENG, INSPECTION FEE IN NTEREST, AGREES TO INDEMNIFY, DEPEND AND HOLD HARMLESS THE CITY OF I LANDSCAPING 2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY INSPECTION FEE FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT DEEMEDTO MODIFY WAIVE OR REDUCE ANY REOUIREMENTCF ANY CITY OFDINAN E 0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT. ANO THAT AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REDUI-ATING CONSTRUC CALL TION: AND IN DOING THE WORK AUTHORIZED THERE By. 00 PERS N WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENS:=4NSURANCE AND RCW 18.27. FOR INSPECTII SIGNA;ZRE (OWNER Of (425) 771-0220 �TION EXT 333 A:FFE 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- CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX SIBS ---- --------- hls . P.—I ­iI.ip.d by 11. "I'l SMO, ­'Y: B'i'T D nd F­ .1 pid. Ild ding . 1. ­"pt i, in sp n p—d.d. oa SI�NA b 11177b ORIGINAL - FILE YELLOW - INSPECTOR PINK -OWNER GOLD ASSESSOR z 'A" rn 00 80 c -4 C m M M Z 10 --1 :". c 0 -01 x m M 0 o C mall M 0 4 z m