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20010565.pdfDATE RECEIVED PERMITEXPIRES us, PER T FEDMONDS CITY OF EDMONDS —E 'UMMVR,,�,n�Zl- E SS 6T'� Ovc'- W 1111E]AIT, A N P M, PPL, CONSTRUCTION PERMIT APPLICATION JAO9D. OWIERMIMIMA11101 I IINESSM CAflTION L N 14 p!�V� SLI PLAT NAMEISUBDIVISION No I LOT NO. L�D 0 EES 5ERT MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP U 0 V e Vj 17110 674 nve. W - EXISTING — PROPOSED — u'=U..: 1­1 e". 0 cl CITY ZIP TELEPHONE E_AhA0lyJ5 REOUIRED DEDICAT ON— FT — WIl­q­d 0 EIER SFI�. OF FIXTURES PRV REQUIRED NAME YES C3 No 0 ADDRESS R MARKS nWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE CITY zip ITELEP"ONE NAME ENGINEERING REVIEWED/DATE I ADDRESS FIRE REVIEWED BY DATE ;ITY ZIP TELEPHONE VARIANCE OR CLI SHORELINE OR ADEI# IN To T o � OYES ONO 7. ��N.� .TATE LICENSE WUMBER EXPIRATION DATE SEPAREVIEW COMPLETE EXEMPT SIGN AREA AU.OWED PROPOSED HEIGHT ULOWED , PROPOSED ROPERTY TAX ACCOUNT PARCEL NO. Z W97 0ocD 012— 00 EXP I I LOT COVERAGE REQUIRED SETBACKS (FT.) PROPO BED SETBACKS FT) 0 NEW Ix RESIDENTIAL 0 LUMBINGIMECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR r ] ADDITION COMMERCIAL ci C MPUANCE OR CHANGE OF USE -r-L'OT-A-REA PARKING PLZNING REVIEWED BY DATE Ip REMODEL C] APARTMENT 0 SIGN REDD I PROVIDED 0 REPAIR 0 GRADING CYGS FENCE 0 1 X T) REMARKS DEMOLISH 0 TANK 0 OTHER 0 CARAGE GAAP.RT 0 RETAINING WALL ROCKERY 0 RENEWAL CHECKED BY T OFCON - -XION �IISUCI c277 0 A— J�_n� OCCUPA ROUP NUMBER NUMBER OF IICAL SPECfik�LINIIIECTOR GA OCCUPANT OF STORIES D.ELUNG UNITS AIR., EAS NUMBER RECIIIII 0 YES LOAD D f ej HEMP, KS PIRCH13RIESS INSPECTIONS PER USC 108fFINAL INSPECTION RED' VALUATION FEE PLAIN CHECK FEE LOT SLOPE I BUILDING PLAN CHECK NO: 1-ITED 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 GAADINGIFILL DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISS SURCHARGE PERMIT APPLICATION; IGO DAYS PERMIT LIMIT. I YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION P P L I CANT, ON 8 5 HALF 0, H, E AND SUCCESORS ENG. INSPECTION FEE H DE �N".E,.R.ILASSIGNS ;A EgR' g, 'P�,NU.l INTEREST, AGREES TO:NIl . G HARMLESS THE CITY OF ANY AND LANDSCAPING MON ALS. EMPLOYEES. ANDAGIENTSFROM FMC, ED DS. WASHINGTON, IS o VER NATURE, ARISING DIRECTLY R INDIRECTLY ALL CLAIMSFoR GA-AGESOFWHATE INSPECTION FEE RECEIPT FROM THE ISSUANCE OF THIS PERMIT. ISS ANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORD NANCE NOR LIMIT IN ANY WAY THE CITY'S ABILITYTO ENFORCE ANYORDINANCE PROVISIOW' TOTAL AMOUNT DUE I HER58YACKNOWLEME THAT; H`V E READ THIS APPLICATION; THAT THE INFORMATION A!'PL15,,ATI�N APPRIUVAL GIVEN IS CORRECT. AND THAT AMT.EOWNEn.oRTHDLyAUTHoRI110AG�NTOI I, ", '. , I. . . P.-I, w-'.'Q­ ,I:. THEOWNER, IAGREETOC WITHICIT AND GMT, STATE LAWS RB.."'N. CoNSTRUC� CALL 'o"'F Deputy: a.dFtItteald Plid—d TION. AND IN DOING THE WORKAUTH RIZED THEREBY, NO PERSON WILL BE: EMPLOYE RELATING TO FOR INSPECTION eFe,ple ,k­I,dgld.,, 1­8 pl-ded. IN VIOLATION OF THE LABOR CODE'OF THE STATE OF WASHINGTON WORKMEWS COMPENSATION INSURANCE AND RCW 18,21 -1 (425) IOWNER A G, `Tr"fvv\ EIIEAIIIED - 0 771-0220 �V — 1 AftENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 ORIGINAL -FILE - YELLOW - INSPECTOR A FINAL CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK-OWNEA - GOLD -ASSESSOR sma m '0 C, 0 r In z Om m M a 0 co co z z 0 a m RECORD OF INSPECTIONS �DATE RECEIVED FPERMITEXPIRES U'E T p PERM CITY OF EDMONDS NUl'ER,00,lP/- CON�TRUCTIONPERMIT APPLICATION JOB SUITE/APTl ADDRESS -7lia 67fl� Ave. W. OTR PLAT NAME]SUBDIVISION NO. I LOT NO. LID NO, U. FEE S 5 Ny � -1 _-SL& MAILING ADDRESS 17110 67 4!, 6V�. Vj. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXIS ING — PROPOSED— ­­., 0 .% Illu- =*.,� 1 8 P"­' 0 9LOM-15 too 2_.�t REQUIRED DEDICATION— FT — 0 um.m." W" q,,w 0 NAME L56iA__e_ METER SIZE I LINE SIZE I H...IFIXTURES I PRV REQUIRED YES C3 No 0 JAMIDREME F MARKS WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL�DRAINAGE CITY _F�_TLEPHOIE NAME FIRE REVIEWED BY DATE ZIP I TELEPHONE STATE LICENSE NUMBER EXPI—ONUATh CHEUKEDBY REG-D.. POSTED I E3 YES I SEPA REVIEW COMPLETE E�EMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED IROPERTY TAX ACCOUNT PARCEL NO. Z W197 Cc) oli- oo Exp I I I LOTCOVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) 0 NEW E] PLUMBING f MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UASIDE REAR AD ITION cl COMPL ANCE OR CHANGE OF USE PARKING REO-D I PROVIDED LOT ARIA PLANNING REVIEWED BY DATE F Mo E DEL C3 SIGN E] F NCE 0 REPAIR El GRADING CYDS I FEIVAR.. _x _FT) DEMOLISH C] TANK OTHER WALL RENEWAL 0 GARPORT 0 CARAG PRETAK101'N'G DO 1 (TYPE Or USE. BUSIN��TIWTY) EXPLAIN: CHECKED BY �zr 1 `17 (0lcRc0uuppAZ5 NUMBER OF NUMBEROF DWELLING CRITICAL AREAS - - SPECtAL.I.NSPECTOR FRE.AR�S OCCUPANT STO NUMBER IA04EA EOU'RE-L REOUIR E3 YES LOAD DESCRIBE WORK TOT, DONE j PLAIN CHECK FEE HEATSOURCI GI-AlING LOTILOPE BUIL.I.. PLAN CHECK NO: IVESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVE S `K'O IC tZ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL DOMAIN (CLASS. SIDEWALKS, DRIVEWAY , MARQUEES, ETC.) WILL REQUIRdE SEPARATE PERMISSION. SURCHARGE PE MIT APPLICATION: 1110 DAYS PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENO. REVIEW FEES SEE SACK OF PINK PERMIT FOR MORE INFORMATION `-'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE IN INTERE T. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F LANDS OAPING a EDMONDS, WA HINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENYS FROM ANYAND ALLCILAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY INElEl �TQN FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITYORDINANCE PLAN CHECK DEPOSIT NOR LNTN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINAN�:E PROVISION.' TOTAL DU E HER5BYACKNOW EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATI N _AlOUNT GIVEN S CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF T EOWNER. AGREETOCOMPLYWITHC1 Y AND STATE LAWS REGULATING CONSTRUC- CALL TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIO WORK N ION INSURANCE AND RCW 18.27. DATE SIGNED (425) ==AGE A 771-0220 AltENTION EXT 1333 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. UBC SECTION 109 FAX uffz 151y 1 2&lL APPLICATION APPROVAL �,, ppI,­­i,, ot , p,,,,t u,bI ,g-d by Ih, g Oul.1 b, , -., D.Pul,: .,,d F­ b. ­d. �d ­.,­ .�!,­I.dpd,� p.,. p­,d.d. LS SIGN�TYRE DtTE RELEASED BY PFATE ORIGINAL -FILE - YELLOW -INSPECTOR PINK -OWNER - GOLD -ASSESSOR z 0 rn 80 rn 0.n .n mm 0 z m