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20030055.pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER­i1PfE/NAME OF BUSINESS 4S ;ff )_12 9/ MAILING ADDR9§S 7 Are — CITY z1f TELEPHONE .]�O/,qow e�� NAME ADDRESS CITY NAME ADDRESS CITY STATE LICENSE NUMBER ZIP TELEPHONE CBL N ZIP TELEPHONE EXPIRATION DATE I CHECKED PROPERTY TAX ACCOUNT PARCEL NCI, �dl'l r9- 76:3 3 ro oo zoo — NEW H RESIDENTI 0 PLUMBING / MECH X_ ADDITION R COMPLIANCE OR COMMERCIAL 0 CHANGE OF USE E REMODEL MULTIFAMILY 0 SIGN REPAIR GRADING CYOS FENCE X F DEMOLISH TANK OTHER GARAGE CARPORT RETAININGWALL 1:3 ROCKERY [3 F E SPRINKLER FIRE ALARM (TYPE OF USE, BUSINESS OR A17 L1,N: NUMBER OF CRITICAL ------ OF tNUMBER DWELLING AREAS STORIES UNITS NUMBERZ��t_ DESCRIBE WORK TO BE DONE /, " w6ael&,0�1 USE ZONE JOB ADDRESI:2,,� PERMIT EXPIRES PERMIT NUMBER SUITE/APT# PLAT NAME/SUBDIVISION N6. LOT NO. LID NO. LID FEE $ TESCF APPfOVGG PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Ponnit Required Street Use Permit Req'd EXISTING — PROPOSED Inspection Required 13 Sidewalk Required 93 REQUIRED DEDICATION— FT Underground Witing required 0 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES 13 NO 13 z REMARKS N OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 1 4 -54:! -,- � 44115- ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE 1 11 VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND _IE3 REO'D POSTED I YES 13NO 1$ SEPA REVIEW SIGN AREA I HEIGHT COMPLETE . EXEMPT I ALLOWED , PROPOSED ALLOWED , PROPOSED I I I EXP LOT COVERAGE ALLOWED REQUIRED SETBACKS (FT) FRONT SIDE REAR PROPOSED SETBACKS (FT) FRONT LIRSIDE REAR PROPOSED PARKING LOT AREA PLANNING REMEWED BY DATE REaD I PROVIDED FT) REMARKS CHECKEDBY I TYPE PF CONSTRUCTION 6� OCCUPANT GROUP SPECIAL INSPECTION AREA OCCUPANT 1011/ W -Do 5F_ 1( P,2_w,�Iw HEAT SOURCE GLAZING % - LOT SLOPE % PLAN CHECK NO, VESTED DATE �n') THIS PERMIT AUTHORLMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOEMN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: ISO DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS N 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 MATURE. 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.' I I HERE13Y 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 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMfkkSATION INSURANCE AND RCW 18.27. S REQUIRED C] YES REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D d— � - A� — j - � ­ __ r2 'r- 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 # Landscapelnsp. Total Amt. Due Recording Fee Receipt # I CALL FOR INSPECTION IA95) %-we- 771-0220 APPLICATION APPROVAL This applicadon is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid. and Rcolpt Is acknowledged In space provided. OFFI SIGNATUflE I DATE Q(IWAA 14.)JIj 1 ?41 'Z4(4 44 ME J' oc=- RE—LEAS110 By Lip, I *rrENTION "I 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 - OWNER - GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING L z 0 0 M FINAL PROJECT APPROVAL FORM TO: — DATE: z 9 0 m :q 9 us 4 MO 0 80 3: M m 10 z o -n n m M a 5 0 r- 0 M a (j) ic 0) M 0 Z X z co) z 0 m 3. RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date si ocaprvl.doc.l:temp:bldg:formsIO/OI QDATE RECE�� PERMIT EXPIRES PERMIT CITY OF EDMONDS ZONE NUMBER ILI no An I 1f% ILI JOB SUITE/APT# 1171 %.f I Brij 04 1%j OWNER NNAENAME OF"BUSINESS MAILINg-ADDREDS -5 7 A CITY cs�oc Zl�,7 [TELEPHONE _A149711 40/ le�4 / NAME ADDRESS CITY NAME 0 pv'�fe?/" ADDRESS CITY STATE LICENSE NUMBER ZIP ITELEPHONE ZIP I TELEPHONE 'CBL0 ADDRES:2 - 7N2 2a-7�4 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP App"ried Requ ad Rw Perm ir Street Permh AWd EXISTING — PROPOSED Inspection Required Sldewa* Required REQUIRED DEDICATION— FT Undergmund WiMg required 13 METER SIZE LINE SIW7. OF FIXTURES PRV REQUIRED (3 I YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE FIRE REVIEWED BY DATE ul I IM, VARIANCE OR CU SHORELINE OR ADB# I INSPECTION I BOND CHECKED BY REO'D POSTED 13YEs ONO $ SEPA REVIEW SIGN AREA HEIGHT .1. ^wen DOADACCn PROPERTY ITM ACCO 'PARC Nn- 50 0 COMPL E EXEMPT ALLOWED PROPOSED fo EXP , 13 NEW RESIDENTIAL X PLUMBING/MECH LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT) FRONT SIDE REAR PROPOSED SETBACKS (FT) FRONT LIRSIDE REAR 13 ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE Ath PARKIjfWj# )�REA PLANNING REVWto BY DATE REMODEL 0 MULTIFAMILY SIGN REOD I 0 REPAIR 0 GRADING CYDS FENCE X REMARKS ( FT) DEMOLISH TANK OTHER GARAGE o RETAININGWALL o FIRE SPRINKLER CARPORT ROCKERY FIREALARM ­ ... o"alkirom no A JAI %I I 1 7 —rPEQ,F CO OCCUPANT la 5g2a& q GROUP CHECKED BY NSTRUCTION CDPE -2 NUMBER NUMBER OF llw�e�zl� Pr7 7 OCCUPANT OF DWELLING AREAS SPECIAL INSPECTION JAREA LOAD STORIES UNITS JNUMBER� �_?9f:L REQUIRED [] YES DESCRIBE WORK TO BE DONE REMARKS 'D 4F - PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ h,,-040We-A7 'x'*// J Cr f �2�// ve��?zy /G:zIpa VALUATION SOCC7��O(� Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % I Building Permit A91W City Surcharge PLAN CHECK NO* VESTED DATE P-)ia '_ ss- C, (_471 Plumbing - Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PMVATC PROPERTY ONLX ANY CONSTRUCTION ON THE PUBUC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERUITAPPLICATIOW. ISO DAYS EAMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMrr FOR MORE INFORMATION BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit ;APJ�U . AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF REO�QN N � EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE IBSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIRCMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Receipt # Recording Fee I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECTI 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 This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPUDYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO Building Olklei or his/her Deputy: and Foos we paid, and FOR INSPECTION 'jecelpt Is acknowledged In space provided. '��TIONINSURANCE AND RCW 18.27. WORKMENS C? OFF1 BIG NATU I��E SIGNATIM� 1425) .4 -nd2 n RELEASED BY ENTION r Off 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-INSPECeT CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESS 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING