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20030012.pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS 14 1 (,A (-�)irm clmuy--.� MAILING ADDRESS (j nt vi 9� :�Y.A CITY ZIP �=LdMT.-- NAME ADDRESS CITY ZIP NAME ICBLN CITY ZIP a I TELEPHONE �I — QaAA-i, qSED L;z2fto STATE LICENSE NUMBER EXPIRATION DA E CHJ ::Z�13 I r-�<z cv7), FV- j n - I I Z NEW RESIDENTIAL LUMBING / MECH �aCOMPLIANCE IADDITION 3 MMERCIAL OR 1:1 CHANGE OF USE REMODEL MULTIFAMILY 0 SIGN REPAIR GRADING CYDS FENCE 0 ( x FT) DEMOLISH TANK [:] OTHER GARAGE RETAINING WALL 0 FIRE SPRINKLER CARPORT FOCKERY FIRE ALARM OWE OF USE. ULISINESS OR NUMBER OF ONUMBER OF WELLING CRITICAL AREAS STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTV ONLY. ANY CONSTRUCTION ON THE PUBUC DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPUCATION: ISO DAYS PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATUREo ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 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. - HERESY ACKNOWLEDGE THAT I RAVE 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 THE LARP*40DE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S fj=N��NCE AND RCW 18.27. RE E ftGENM.0�D__,1 I DATE SIGNED ,&a, I — I PERMIT EXPIRES I I , USE ZONE PERMIT -_7) -Z,/ NUMBER JOB ADDRESS S '6LI 10 "in PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required EXISTING — PROPOSED Street Use Permit RaKjd inspection Required! Sidewalk Required REQUIRED DEDICATION— FT Uriderground Whing required 13 METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED I EsI3 NO C3 REMARKS OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I water system —"'— r—' DATE 19.30.020(c) FIRE REVIEWED BY DATE I U-1, VARIANCE OR CU SHORELINEORADBI I INSPECTION 1, BOND REO'D POSTED 13YEs 13NO SEPA REVIEW SIGN AREA I HEIGHT COMPLETE . EXEMPT ALLOWED . PROPOSED ALLOWED , PROPOSED LOT COVERAGE I REQUIRED SETBACKS (FT.) I PROPOSED SETEACKS (FT) ALLOWED PROP08EI FRONT SIDE REAR FRONT LIR SIDE REAR III a z I 0LOTr%Cky1N RECtOMMODO r �ffifioff&Y DATI 815.1.7 CHECKED BY jTYPjj=ON _=t;UurAb GROUP SPECIAL INSPECTION AREA 0 CCUPANT REQUIRED 0 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D —9 PURSUANT TO ECDC 19.30.020 1 VALUAI IUN THIR WVTER SHI�FF $ - ---L Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapoinsp. Total Amt. Due Recording Fee Receipt N APPLICATION Ai7l)=RVAL CALL This application Is not a permit until signed by the Bulldlna�Qfflci3l o(his/hat Deputy: and Foos are paid, and FOR INSPECTION /-)(--r0:a1pt Is acknowledged In spapoprovIded. (425) kGNATUR I 7ATE 2, ZLEA 771-0220 (1— ED BY DATE ORIGINAL -FILE YELLOW- INSPECTOR PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING MENTION LAI I J;j IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES z 0 0 M M M 0 r M M 10 0 -1111 71 M M 0 0. z co z 0 0 M 11 DATE RECEII I PERMIT EXPIRES I sexless CITf OF EDMONDS USE �!)NE PERMIT NUMBER CONSTRUCTION PERMIT APPLICATION JOB ADDRESS OWNER NAMEINAME OF B INESS C IM PLAT NAME/SUBDiVISION NO. LOT NO. LID NO. A MAILING ADDRESS LA W�� _j Ma ui �4 LID FEE S TESCP Appro"d PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW P01111" ROW1114 use partnit nsqdT CITY ZIP ITELEPHONE EXISTING street — PROPOSED Inspection naquired SWawa* ftequired Eja REQUIRED DEDICATION— FT un&Mmund wrigrequired 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO 13 ADDRESS HE M rYn%7 OMtV%qSCBR (WPbSMW*RQ)jjffe0$WLjDRAlNAGE CITY NAME STATE LICENSE NUMBER ZIP ITELEPHONE CBL # I I rcqturcoonvuei-ourningapplhuxujn I ENGINEERING BY DATE A #11W I - '1MK­!e L.&-Z---R FIRE REVIEWED BY DATE W zip J, TELEPHONE aw: aie .1-A) VARIANCE OR CU SHORELINE OR ADBN INSPECTION' BOND EXPIRATION DATE CH REO'D POSTED bis SEPA REVIEW 17— SIGN AREA 10YEs I 13NO IS HEIGHT A wED , PRO I NO. UUMrLt:lr . EXEMPT I ALLO POSED ALLOWED PROPOSED NCW RESIDENTIAL MON COMMERCIAL JVREMAD 10 ODEL 1:1 MULTIFAMILY REPAIR 0 GRADING CYDS DEMOLISH TANK GARAGE RETAININGWALL CARPORT ROCKERY UWE OF BE, IN rLAIN: �71`M ner NUMBER NWUMBEIR OF 'OF 0 ELL No Q � STORIES UNITS DESCRIBE WORK TO BE DONE HEAT SOURCE PLAN CHECK NO: PLUMBING I MECH t9—COMPLIANCE OR LOT COVERAGEk ALLOWED PROPOSED PURS. REQUIRED SETBACKS (FT.) FRONT SIDE REAR ANT TO ECDC 1 PROPOSED SETBACKS (Fr) FRONT LIRSIDE R EAR .30,020 CHANGE OF USE mr PARKING",' A*(MVFATE SIGN REOD I PROVII o FENCE X_Fl),' REMARKS o OT HEIR I 0 F RE SPRINKLER FIRE ALARM N 111 CRITICAL AREAS NUMBER LOT SLOPE % VESTED DATE THIS PERMrrAUTHHORtZ S ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE D�ONE ON PRIV= PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, 81�_ EwALKS, DRWEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. ERMITAPPLICATION. ISO DAYS PERMIT LIMM I - PROVIDED WORK 19 STARTED WTrH1IN 180 DAYS Yi�ol PINK PERMIT FOR MORE INFORMATION SEE BACH F 'APPLICANT, ON BEHALF OF HIS On HER SPOUSE, HEIRS, ASSIGNS AND SUCCESCIRS IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTOY. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAG ES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE 18SUANCE i iF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY; W IVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY' HE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' I HEREBY ACKNOWLEDGE ­HAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECr AND'HAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO OMPIY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING 7HE wORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LA40R-QQDE OF THE STATE OF WASHINGTON RELATING TO WORKMENS Pp�"NS ,IVNIMA"CE AND RCW 18.27. DATE SIGNED ?`Tvvl� I I -,--I - o CHECKED BY ITYP" —1 SPECIAL INSPECTION REQUIRED OYES BE NSTALLED NEAR GROUP Nr ___ �L OCCUPANT LOAD REMA r 1 8 PRO I NSjPM !!!ION REaD wwotm -0 CS arill expansion tanks gffl P rpnuirgd on SH hot water tanks per $ Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscapeinsp. Recording Fee CALL R INSPECTION j,dqq% V­0) 771-0220 FEE Description FEE State Surcharge City Surcharge Plan Chk. Deposit Receipt # Total Amt. Due Receipt # APPLICATION Arl 90VAL. This appl�catlon Is not a permit until signed by the 5a%PfncIal or hisiber Deputy: and Foes are paid, and : r Ipt Is ack afted In spacepovided. ATTENTION Off 1 3 IT IS UNLAWFUL TO E OR 0 A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANC) HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES IGNATU PATE .13 BY DATE ORIGINAL -FILE YELLOW- INSPECTOR PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING . ... .........