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20020867.pdf*, o nyju .5 - DATE REC CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION ER NAME/NAME OFUSIN S b 9jor O D1fr 0" ING ADDRESS 3111 far IA/A CITY 21P TELEPHONE Seakic U A . 20107 NAME PERMIT EXPIRESUSE I ZONE PERMIT,/fl ) _ L. NUMBER. 7` ` J JOB ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO, 11 vv LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe mit Required O RW Permit Required t] Street Use Permit Req'd �] EXISTING _ PROPOSED Inspection Required Sidewalk Required E3 REQUIRED DEDICATION Fr underground Wiring required 0 METER SIZE LINE S1ZE NO. OF FIXTURES PRV REQUIRED YES ❑ NO ❑ REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE C TY ZIP TELEPHONE lel8612 AzL4^01 I'ZSGFPO INA a U Inn NAME CBL N7!!Z i ENGINEERING REVIEWED BY WE DATE W ADDRESS FIRE REVIEWED BY DATE ¢ ; CITY ZIP TELEPHONE M Z �6deVARIANCE OR CU SHORELINE OR ADBq INSPECTION BOND 0 STATE LICENSE NUMBER �/EXPI ON DATE CH KED B �_� �r_ s'2��j� ES OONO S POSTED i m �� • / v '� SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED P OPOSED ALLOWED PROPOSED I Mn 0000010 ©7 EXP re; /UC ❑ NEW 1:1 RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) .PROPOSED SETBACKS (FT.) rn ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR z M❑ COMPLIANCE OR�J, ` �= j � � C%�1 �� z 1:1ADDITION COMMERCIAL ❑ CHANGE OF USE J PARKING LOT AREA PLANNING REVIEWED BY DATE a O C 19 REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'G PROVIDED /� No #A%�C QI' m rn ❑ REPAIR 1:1 GRADING CYDS ❑ PENCE X Fn REMARKS ❑ "I ❑ DEMOLISH 1:1 TANK ❑ OTHER r GARAGE RETAINING WALL ❑ FFIRE IRE ALARM LER _ CARPORT ROCKERY (p (TYPE OF USE, BUSINESS OR AqTIVrrf EXPLAIN: O T1 ise'(�wn CHECKED BY TYPE OF CONSTRUCTION IC!2 OCCUPANT NUMBER v � NUMBER. OF CRITICAL—/Y ROUP _ C OF 1 DWELLINGO AREAS SPECIAL INSPECTION AREA OCCUPANT rnm STORIES UNITS NUMBER REQUIRED [3YES LOAD O DESCRIBE WORK TO BE DONEREMARKS t7rn PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9 . DeM011A AkA Ilp.' 4O ? U m r z O R.) oclq G V1 17. d ON.;: -1 p j $ D e is G� L) Wo S 9 I vi1 �Z iy � e wt /'i9r o , Descrlption FEE Description FEE _ Plan Check r State Surcharge z Z HEAT SOURCE GLAZING % LOT SLOPE % _. Building Permit City Surcharge PLAN CHECK NO:Jr VESTED DATE Plumbing. J m 02 i�z Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO � BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading 2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. I= Engr. Review W PERMIT APPLICATION: 180 DAYS n PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION U)'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit r 1` 2 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF .� EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # is ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp, Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCEjilt = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' / Recording Fee Receipt # L 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 • CALLThis application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Foos are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE- OF WAS14INGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided. i WORKMEN'S COMPENSATIO NCE AND RCW 18.27. DATE OFFICIALS SIGNATURE SIGN RE (OWNE R ENT) DATE S NED (425) 9% Z �� 771 0220 R E SED BY, / �7 DATE ATT TION EXT 1333 IT IS UNLAWFUL TO USE ON OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL • FILE YELLOW • lffspvcfon CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK -OWNER GOLD • ASSESSOR 04102 PRESS HARD =YOU ARE MAKING 5 COPIES GREEN ACCOUNTING