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20000988.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION MAILING ADDRESS f3t�' CITY ZIP TELEPHONE 'Rs---A—p LLi,2!4----13-cF3 NAME I - f--_ . -- -) 7 6 1 7 —i7-1 I PERMIT EXPIRES . , USE 200988 ZONE PERMIT NUMBER SUITUAIT, 'OB ADDRESS —Q PLAT NAMEISUBDIVISION NO. LOT NO� L LOT No Ll�'D NO, L , 0 FEE Ii TESCP APP-4 U AL STREET MAP R. P_11 P-11.1 0 PUBLIC RIGHT OF WAY PER OFFICIA, 1-1 U.. e 0 EXISTING — PROPOSED— I I A. U_g_.d REQUIRED DEDICATION IT — WId­­1- METER —SIZ PRV REQUIRED E I LINE SIZE 10, OF FIXTURES 0 YES 0 No R MARKS FC'.R OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONT AINA.E ADDRESS - -L FIRE REVIEWED By DATE BOND SITATE110ENSEN-111 VARIANCE OR CU SHORELINE OR ADS# OTION I INSPEC RE 0 OYES ONO POSTED —SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED PROPERTY TAX ACCOUNT PARCEL— , EXP I LOT COVERAGE UIRED SETBACKS (FT.) PROPOSED SETBACKS JFTJ [3 NEW RESIDENTIAL PL ... 11 DIM CH ALLOWED PROPOSED FRONT SIDE REAR FRONT UP SIDE REAR [3 ADDITION COMMERCIAL 11 c3 C MPLIA CEOR OF USE CHANGE EDBY DATE 13 REMODEL C] APARTMENT F1 SIGN REC-D I PROVIDED REPAIR RAMN. CY,. E] FENCE X FTI RE-F- DEMOLISH 0 TANK o OTHER 6 'AGE [3 RETAINING WALL RENEWAL 1;AARP.FT ROD �' ._ 0 0 ' CTIVITY) EXPLAIN: I' ITYPEfgr;=1 A CHECKED BY CONSTRUCTION CODE OCCUPANT ITY' GROUP NUMBER N SPECIAL INSPECTOR JAREA OCCUPANT OF PEOU'RED LOAD '0 STORIES E] YES DESCRIBE WORK TO BE D N FENIARt<B PROGRESS INSPECTIONS PER UBC 10811INAL INSPECTION REQT CA Mkh�r 11 1 r) whether the w"ter gatem 3,1,1 is open. or dosed, expansion tanks are all not water lanks per 'eBe VALUAT10N FEE PLAN CHECK FEE GLAZING % LOT SLOPE Y, BUILDING PtWCHECK NO: IVISTED 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 GRADINGIFILL DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE BERASATE PERMISSION. SURCHARGE PERMIT APPLICATION; 180 DAYS PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED W ITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION ,.,,.E.ALFG, OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS :Ap ;L Tc, N —TH I I F eNG. INSPECTION FEE IN �NDEM DE D N H L AR LE S THE INTEREST. AGREES TO NIFY. P AN PL YE S. AN A ENT A 'A'ING LANDE� INSPE TION FEE MO S S. 2 ED NO WASHINGTON. TSOFFICI L E - ALL CLAIMS FOR DAMAGES OFWHATEVER I E. ISI I E TLY RiN I TLY T E REO"P T IS P I FROM THE ISSUANCE OF TH S PERMIT. I U N E FT E IT SHALL N RD AN E PLAN CHECK DEPOSIT Y Y ITY DEEMED TO MODIFY. WAIVE 0 R REDUCE A RE Ul E ENT FAN P Y R INA N F VISI N.' FGCE 'SA NOR LIMIT IN ANY WAY THE CITY BILITY ENF RCEA TOTALAMOUNT DUE HAVE READTHISAPPL ATION.. THAT THE INFORMATION ICE 'AUTHORIZED APPLICATION APPROVAL DGETHATI 'HE 7Y A..N-WL M THE OWNER 0 AGENT OF .tV A IS CORR G AT A ORTH DULY �N ECT!AN TH W ­, e,e,j 1,,le ey the � S REGULATING CONSTRUC- THE OWNER I AGREE TO STATE CALL hd 1— .1. p,,d. TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PE RSONWILLSE EMPLOYED RELATING TO he.,,, .�—wl.dled FOR ... p—ld.d. INSPECTION IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON WORKMEN'S COMPENS:�PN IN,SI)RANCE AND ACW 18.27, 0 IALS S!G ATURE DATE (425) NATURE (OWNER 0 A gKf) 4 1 771-0220 GAT ELEASEY) BV-- EXV333 ATTtNtION IT IS UNLAWFUL OCCUPY A BUILDING 08 STRUCTURE UNTIL 771-0221 TO USE 08 OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR A FINAL INSPECTION HAS BEEN MADE AND APPROVAL CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR 5198 z a rn c: 0 m 0 80 c Ic X m I ID c Q0 0 -n IT :c m M 0 0 c m In 0 z z 0 =j 0 m oc 0 -n m M .mo DATE RECEIVED PERMIT iRES:w Z.�E /pl5 g CITY OF EDMONDS — NUMBER CONSTRUCTION PERMIT APPLICATION 'A OS.ESS SUITEIAPT# &NAMpWM7E;0Fr9fll I uUNO- PI-AT NAMEISUBDIVISION NO. I LOT NO, oTn I I A LID FEE S MAILING ADDRESS -A fkA-C PUBLIC RIGHTOFWAY PER OFFICIALSTIEET MAP 7-EICP R_ �b_ U.. EXISTING - PROPOSED� .­­ R.luk.0 0 CITY TELI HONE S-1,1, R�q ­ 0 ,iZD(_p 'Z, (n PEOUIRED OIDIGATION_ IT - U..".- ­"K, 1-1. a -METER SIZE LINE SIZE NO, OF FIXTURES PRV SECURED NAME I I YES 0 NO 0 P MARKS EWNER/CONTRACTOR ADDRESP 0 RESPONSIBLE FOR EROSION CONTROUDRAINAGE Z FIRE REVIEWED By DATE ilTly ��,QCLAU_ ZIP `6 VT7 -�LEPHONE U0) ;y VARIANCE OR CU SHORELINE OR ADS. INSV P OYEB �TATE LICENSE NUMBER T TA LID& ,D P,5Rrc,�)Z2 tfo ENjn E-l-Q. DATE .. ...... SEPAREVIEW COMPLETE I EXEMPT EXP SIGN AREA ALLOWED I PROPOSED _�EaUIRED HEIGHT ALLOWED I PROPOSED ROPERW AX ACCOUNT PARCUL N.. R TY I AX E] NEW RESIDENTIAL "Q� PLUMBING I MECH ci COMPLIANCE OF ADDITION COMMERCIAL CHANGE OF USE REMODEL C] APARTMENT C] SIGN 0 0 REMO EL $�bREPAIR C] GRADING Y.E C] FENCE X FT) DEMOLISH TANK C] OTHER o GARAGE C] RSTAINlNG WALL 0 RENEWAL CARPORT ROCKE LOT COVERAGE ALLOWED PROPOSED SETBACKS IT FRONT SIDE REAR PROPOSED SETBACKS (FT.) FRONT UPSIDE REA PARKING VIDSG LOT AREA rONINO REVIEWED BY DATE REDD I PRO -1 CllCKlD3Y ITY STRUCTION FF6 1 NS JCOOE 111URAITE (q7 GROUP NUMBER OF NUMBEROF 'WEL LNG NITS URIETAICAL AR S EF NUMEIE Ij SPECIA RL�INSPECTOR REOU 0 YES JAIEA AREA LOAD DESCRIBE WORK TO BE DONI_ IZO ptaa , REMARKS REMARKS PROWESS INSPECTIONSPER UBC 1081FINAL INSPECTION REO k PLAIN CHECK FEE LOT SLOPE % BUILDING rMT �::�GIZING771 PLUMBING PEAKCHECK NO: VESTED DATE MECHANICAL _::� THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC G9ADING/FILL DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SURCHARGE A SEPARATE PERMISSION. PERMIT APPLICATION: 1IMBAYS PERMIT LIMIT'. I AR - PROVIDED WORK IS STARTED WITHIN 160 DAYS ENG. REVIEW FE S SEE SACK OF PINK PERMIT FOR MORE INFGRMATION ING. INSPECTION FEE ON BEHAL F OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS LANDSCAPING INSPECTION FEE ;APPLICANT. INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF N NTRETAGR"S To ANYAND E MoN.S,.ASHIN.TON. IT. OFFICIALS, EMPLOYEES, AND AGENTS FFOMDI CTLY ALL CLAIMS FOP DAMAG ESOF WHATEVER NATURE. ARISING DIRECTLY ORIN RE RECEIPT FROM THESSUANCE OF THIS FERMI, ISSUANCE .1 THIS PERN41T SHALL NOT BE PLAN CHECK DEPOSIT D EMED TO MODIFY, WAIVE 08 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 5 Y'S ABILITY TO ENFORCE AN' ORDINANCE PROVISION.' ' NOR LIMIT IN ANY WAY TH E CIT TOTAL AMOUNT DUE T 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 01 I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Th­ppI­b'­ - , p"'i"til llg�ed by th, oilwai ., himll., D­Iy: .�d F­ .. p.,d. .�d THE OWNER. TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED OF WASHINGTON RELATING TO FOR INSPECTION ,tdl�g ...,p, -- IN VIOLATION OF THE LABOR CODE OF THE STATE WORKMEN'S COMPENSATION INISVRANCE AND RCW 18.27. - , 6ALS S,IG ATURE DATE _joWNER OPIAGENf) o ITESIGN'D (425) ?NATITRE �SIQ 771-0220 RELEASE B EXTJ333 ATT_kfftION IT IS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLO . INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 1.8 FAX PINK OWNER GOLD - ASSESSOR z 9 0 c m Ill 0 -4 0 00 c -4 E m M M z 0 -n rri rn 0 0 o C 0) c. z z 2 0 m m