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20030011.pdf4 DATE RECEIVED I �—1 -I CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME QF BUSINESS MAILING ADDRE -7 CITY NAME ADDRESS CITY NAME ADDRESS 7� STATE LICENSE ZIP TELEPHONE ZIP TELEPHONE _TCBL �07 zip TELEPHONE '�1,1101 2,CU-2� EXPIRATION DATE �:H Lo- US ROPERTY TAX ACCOUNT PARCEL NO. PONEW RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY REPAIR GRADING CYDS DEMOLISH TANK oGARAGE RETAININGWALL CARPORT ROCKERY (TYPE OF USE, BUSINESS OR ACTIVEM EXPLAIN: NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE � PERMIT EXPIRES'l I �P. 0 USE ZONE PERMIT NUMBER JOB ADDRESS SUITE/APT# 2- .5 tsu) PLAT NAME/SUBDMSION 1-107— [73= LID NO, LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Approved AW Perrdt Required Stroat U69 Permit Req`d EXISTING - PROPOSED - Inspection Required Sidewalk Required REQUIRED DIED P" riderotound king required 13 MhttK SI E aBiw BY F MY IM RV REQUIRED 0 OAD C3 3 CURB 1 NO 6 REMARKS z OWNERICONTRACTOR CONTROL/DRAINAGE RESNrihfffi —dir— — reaufred on fuel-bunIng applianm In ENGINEERING i"69fiBled spaces. UMIC 81NFV FIRE REVIEWED BY DATE ul W VARMANCE ORCU SHORELINE OR ADB# INSPECTION D BON" REO'D POSTED 10YEs 13NO is $EPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT I ALLOWED . PROPOSED I ALLOWED , PROPOSED LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT) PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR I FRON T L/R SIDE REAR COMPLIANCE OR I CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE SIGN I1E11D I I PROVIDED I 0 FENCE ( X FT) REMARKS OTHER SPRINKLER oFIRE FIRE ALARM - K--,o CHECKED BY ITYPE CRITICAL j AREAS SPECIAL INSPECTION NUMBER REQUIRED [3 YES L OCCUPANT GROUP OCCUPANT LOAD REMARKS i PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D V 'nON ALUA $ Doscription FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading 3 DOMAIN (CURBS, SIDEWAILKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 111110DAYS PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF H!S OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDM , WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt III L CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. 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., �0 z -- Recording Fee Receipt # 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- CALL P, Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF TH DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIC )N jT�h�ppllcation g Rcial or hisfhor Deputy: and Fe as are paid, and I C-I pt is acknowledged in space provided WORKMEN'S 'POMprVj;9;kU NCE AND RCW 10.27. C IGNATURA DAT S DATE SIGNED AGE" 1A0 TIF -5) -3 771-0220 EASED BY ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW. INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK-OVVNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING r I DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER 11AME El BUSINESS cLA n M MAILING ADDRESS �J. U-1Y)a joca+i I "f*-*�'-T�ao 'CITY ZIP I TELEPHONE NAME ADDRESS CITY ZIP LL NAME wig"�'m ADDRESS f rVd 1A Al CI zip 'j TELEPHONE Sec"j, 9<�119 120(,-- STATE LICENSE NUMBER EXPIRATION DA W PROPERTY TAX ACCOUNT PARCEL NO. N [PERMIT 4_7 1 C) EXPIRES USE PERMIT ZONE NUMBER ;�W 3P — 60 1 f JOB SUITE1APT# ADDRESS Lial'o —fl- :�L� ) PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Ap RIN pernin ad Street Use Peffn Rald EXISTING PROPOSED Inspection Required REQUIRED DEDICATION- FT Sidewalk Required Underground Wiring required METER SIZE LINE SIZE NO. OF IXTURES PRV REQUIRED 11� YEs13 NO C1 z REMARKS OWNER/CON DATE 77� FIR FtVqlfftW on W cc thid-buming appUmCgIn 1111111111heSW =8CM IM4V Qic ii my - VALOR CU SHORELINEORADB# I —INSPE6flON [BOND OSTED DYES 'bNO'F&-- SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT LOWED . PROPOSED I ALLOWED . PROPOSED 0 EW RESIDENTIAL PLUMBING / �ECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBAC4_(F�j N pe 0 ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R-SIDE REAR ADDITION COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE I — PARK VIDED LOT AR EVIEWED BY DATE ING EA PLANNING R REMODEL MUI.TIFAMILY SIGN REQ`D PRO I z GRADING o FENCE ]\EPAIR CYDS X_ FT) REMARKS DEMOLISH.*. [3� T:A�NK' 0 OTHER 0 GARAGE -1 RETAININGWALL FIRE SPRINKLER CARPORT 13 ROCKERY 13 FIRE ALARM (TYPE OF USE, BUSINESS OR ACTIVTM EXPLAIN: CHECKED BY ITYPE OF CONSTRUCTION OCCUPANT, '0 .7 3 K_,, GROUP I NUWkR NUMBER OF CRITICAL OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT STOR ES UNITS NUMBER REQUIRED [] YES LOAD DESCRIBE WORK TO BE DONE REMARKS .Si a IncQ V)2_f:k: PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D Mob (Ad --Pa I t"4 PnRA u 61) lcoofiq__�' -_7n� t uz, VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE % LOT SLOPE % r Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO 17 U_ t: a 3 BE DONE ON PRPJATE PROPERTY ONLZ ANY CONSTRUCTION ON THE PUSUC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review PERMIT APPLICA'noN;* 180 DAYS PERmrr umm i YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection SEE. BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, 13EFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFV; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN 13 CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- Th n is not a permit unfit signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL 0 IfIcial or his/her Deputy: and Foes are pt9d, and IN VIOLATION OF THE �ABO*CNkDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTI olpt Is acknowledged in 3PaCO provided. ON ',jC"1UPfNC WORK!M!E!fOM E AND RCW 18.27. L 'SIGNATUR!& DAT SC AGENT) DATE SIGNED 1425) na ()ES -0220 LEASED BY DATE 771 dil't ATTENTION Off 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING MEN L... z 0 0 M M M 0 0 C M M z CA 0 _n M M FT, C z C4 z 0 M