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20020238 (2).pdfI DATE RECEIVED [PERMIT EXPIRES Eizz --- I U CITY OF EDMONDS Z CONSTRUCTION PERMIT APPLICATION A OWNER NAMEINAME OF BUSINESS _qrt,q-4j+/3,-&t,f MAILING ADDRESS lo6qj 04KRIbiGiF Z) r I'v C_ CITY ZIP TELEPHONE WMCFONII�i P#. /50go 1/-7)ty- NAME r3 A.-Sta fj C'm ju " V )_,F9 ADDRESS eO'7 57-1 CITY ZIP TELEPHONE jMu1<t1zL-eo, JJ14 4.1.;ii,5-_ -)cjS,65r6j? !AME a, le P/1 A 456 ADDRESS f=.00* 10 CITY ZIP TELEP�HONE STATE LICENSE NUMBIfR EXPIRATION DATE C ECKED BY -72 Tib Vg Ica PROPERTY TAX ACCOUNT PARCEL E 0 NEW RESIDENTIAL *PLUMBING / MECH ADDITION [3 COMMERCIAL [3 COMPLIANCE OR 00 CHANGE OF USE REMODEL APARTMENT [:1 SIGN [3 REPAIR o GRADING r FENCE 0 .Ynq ( _ X Fr) [3 DEMOLISH [3 TANK [:I OTHER 13 GARAGE c3 RETAINING WALL CARPORT ROOKERY RENEWAL M?E OF USE. QUILINESS OR CTPM'Y) EXPLAIN: NUMBER NUMBER OF CRITICAL DWELLING UNITS A N DESCRIBE WORK TO BE DONE A)Rt,j a'(d,4-ed-A, ado 5 0 k hmn nuatA brz-rjyl�o L ko fA D er-Al, A+j U!ii /0 La emuclac::0 F-Cer-bl= r,tg) dp\t r-12.0nk3T_ HW WURCE &)q 5 —GLAZING % D" %-'CFL LOT SLOPE % PLAN CHEC W!, yz'La VIES1 ED DATE THIS PERMIT AUTHORGMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO h BE DONE ON PRIVATE PROPERTV ONLI ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS. ORMVAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: ISO DAYS PERMIT LIMrIft I YEAR - PROVIDED WORK IS STARTED Wn`HIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION I 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS IIN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 91 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 2 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION 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. TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THEL6BOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENIM&*ANSURANCE AND RCW 18.27. BIG E (0 GENII� DATE SIGNED e% SE PERMIT NUMBER OB SUITE/APT# DDRESS ?,N W C PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Peffrift Req'd EXISTING — PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground Wiring required 13 METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED 7. YESM NO 13 z REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 11 - - ___ I.-- - , ___ 'et 71______ - fit— i i CPf0L- -%4f -�f r-e46- rfPe0`4dVZ e&k. O*t 41OV4g;� f /Aar.40- S&oW 41 4 !NGINEERING,�� REVIEWED/DAI E 9wee :014L.0 2..., 'IRE REVIEWED BY DATE Ir VARIANCE OR CU SHORELINE OR ADO# INSPECTION BOND REO'D POSTED I C3YES,Y�rNO BEIRA REVIEW SIGN AREA HL!4GHT 'OMPLETE EXE7MT ALLOWED PROPOSED ALLOWED, PROPOSED A Xp— LOT COVERAGE REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (Fr.) kLLOWED PROPOSED FRONT SIDE REAR I%jR01JT. L/RSIDE REAR RAW 4 A 7 IfARKING REOD PROVIDE LOT AREA, PLANNING REVIEWED IfY DITE I ,HECKED BY CTION — OCCUPANT JTYPE,* �MR ICODE q711 GROUP ;e 3 'PECIAL INSPECTOR I �ffoc CUPANT 4EQUIRED [] YES JAREA,L)MOC: L4 13 4 iav ,, AD 1EMARKS IROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D --j-.-j —.9. #A..o I a V.4 I i --1A"VM - d__4 1 0 VALUATION $ FEE-0 I Description I FEE Plan Check Building X-1 19 Plumbing Mechanical Grading Recording Fee Engr. Review e5b city surcharge Engr. Inspection State Surcharge Traffic Mitigation Plan Chk Deposit Fire Review Receipt # Fire Inspection Total Amount Due Landscapelnsp. Receipt # CALL FOR INSPECTION (425) 771-0220 APPLICATION APPROVAL This applicaltion is not a permit until signed by the Building official or histher Deputy: and Fees are paid. and focelpt Is acknowledged In space provided. OFF19ALS SIGNATURE DAJE 4 —R DATE' A"17T EhTId(N Off 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL /fx_1_ A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI. 771-0221 ORIGINAL -FILE - YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD -ASSESSOR 10/01 z 0 0 IT! k M M 0 -40 0 11711 M z o -n ,n M M DO-) 0 o Fn C co) C CO) M C) X z 0) z 0 0 M Uzi ;E�EIVED PERMIT EXPIRES CITY OF EDMOINDS use PERMIT ZONE' NUMBER CONSTRUCTION PERMIT APPLICATION 20DAESS SUiTE/APT# 7— OWNER NAME/NAME OF BUSINESS PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. MAILING ADDRESS LID FEE S OA K R I br. IF PUBLIC RIGHT OF WAY PER OFFICIAL- STREET MAP YESW Approved RW PwrM ReWhed "CITY ZIP TELEPHONE EXISTING PROPOSED Street Use PenrA RoWd kispecdon Roquk*d Sidewalk Rw;uirod 3 REQUIRED DEDICATION— FT UndKWOund VAring requked 13 NAME METER SIZE LINE ;��. I OF FIXTURES PRV REQUIRED A YES 13 NO 13 ADDRESS REMARKS f�67 S-7-; OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE -.? kj CITY ZIP - TELEPHONE a NAME 01 4 ADbREss Sh ENGINEERING REVIEWED/DATE e,,r - - 51-610 Z, CITY ,*- t%,%Io/ ,gq TELEPHONE FIRE REVIEWED BY DATE 9C IE ��A&dw"2 26 STATE LICENSE NUMBtR EXPIRATION DATE CHECKED BY VARIANCE OR CU SHO RELINE OR ADB# INSPECTION RE 'D BOND POSTED E3 YES NO- SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL COM PLETE EXEM T 7 ALLOWED PR OPOSED LLO 'PRO POSED 0/944 EXP' .7 NEW.. RESIDENTIAL *P LUMBING MECH LOT COVERAGE ALLOWED - PROPOSED REQUIRED SETBACKS (Fr) FRONT SIDE REAR PROPOSED sETeAdks (Fr.) 0 LIR SIDE REAR 1z ADDIT110N COMMERCIA L [3 COMPLIANCE OR MIA h APARTMENT [3 CHANGE OF USE [3 SIGN IIARKING REOD PROVIDED LOT AR D PLANNING REVIEW14EDY ATE CL I 21, I 9___ 13 REPAIR T3 GRADING CYOS [3 FENCE X Fri R FrK 54hAve-,5: DEMOLISH TANK [3 OTHER ePy/"_1 -kir- �74� c3 GARAGE RETAINING WALL L-J CARPORT OCKERY RENEWAL A ;A I I dpgq—e "E OF USE, OR ACTIVIM EXPLAIN: 7 CHECKED BY TYP CTION CODk_ OCCUPANT G p ROU NUMPER 0 Oi.1 NUMBER OF 1 DWELLING CRITICAL AREAS SPECIAL INSPECTOR REQUIRED JAREA U TCCUPANT OAD " Ro 0 YES ia 0 </0 DESCRIBE WORK TO BE DONE WIR4i addCl(_ R4101ARKS OGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REGIOD A o, K,- a.:/ /� of K c -T I kKw- li�e_gcw ___ - z 9 0 ITI M C M 0 80 C M io C _Z 0 Irl MITI 0 0 Fri C 0) M Z X W MM I a 11 2. i A A0 AIIIII5WAINUMMW "A Alm I F.VA I L [C 0 0 4V =E chanical t: THISPERMfIrM THIS PERMIT COVERS WORK TO .TE :W WORK NOTED �i: BE DOME ONLX ANY CONSTRUCTION ON THE PUBLIC 01::CAM Ropr ding Recording Fee DOMAIN -(CUP^ SIDEWAILKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. �Wr. Re view City Surcharge PERmrir AppucATio" PERW ILIMM I YEAR -PROVIDED WORK IS STARTED WTTHIIN 1180DAYS ingr'.'Inspection State Surcharge SEE BACK OF PINK PERMnr FOR MORE I=T�n 'APTn &IS HEIR��4'WAS'AZ SUCCESORS q W We Traffic Mitigation Plan Chk Deposit EMNlFQY,0EQU;k IN RE , 0, . FEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON. ITS P"ICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt # ALL CLAIMS FOR DJAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMrT. ISSUANCE OF THIS PERMIT SHALL NOT HE Fire Inspection Total Amount Due DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE, CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Landscapelnsp. Receipt # I HEREBY ACKNOWLEDGE THAT-1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVA L arm 'm coRREcr AND THAT I AM THE OWNER. OR THE DULYAUTHWIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWSAEGULATING CONSTRUC- CALL This application Is not a peffnft until signed by the TK)N: AND IN DOING THE WORK AUTHORIZED THEREBY. NO�PFRSON WILL BE EMPLOYED Building Official or tdsftw Deputy: and Fees as paid, and IN VIOLATION OF THE)L.ABOR CODE OF THE STATEL!DW'WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN-8 COM1PENfATION4,NSURANCE AND RCW 18'.27. 1A63 OFF'rAA_Ls SIGNATURE E 1,�A Blow DATE SIGNED 7RII %425) 771-0220 RELE17L DATE ATTEW10W fO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL M 1333 IT Is UICLAWFUL 771-0221 Ir A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YRUJOW-'INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 1 FM PINK - OWNER �00 . LD - ASSESSOR 10101