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20030089.pdfI Q X DATE RECEIVED j I I CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION 0 ,TER NAMEINAME OF BUSINESS " 1v.4.,;, Opt MAILING ADDRESS Ll IVI--Z -le -3y-C-30 CITY ZIP TELEPHONE r � Ile LIL-4e NAME Gto- k-kcioL ADDRESS CITY ZIP TELEPHONE C0 0^7 Ok NAME CBLN m e (,tr ADDRESS to 0 t&j 5 —0 Oz f 2— ZIP 1 TELEPHONE letlj4e STATE LICENSE NUMBER EXPIRATION DATE CHECKEDO J13Y mec -13 4�/:' 2s- TAX ACCOUNT PARCEL NO. 114,6e — 2-0 e NEW RESIDENTIAL XF Msere LUMBING / MECH ADDITION OMMERCIAL 1:1 COMPLIANCE OR )ec CHANGE OF USE OREMODEL MULnFAMILY 1:1 SIGN 0 REPAIR GRADING 0 CYDS [3 FENCE X FT) [—] DEMOLISH [3 TANK [3 OTHER oGARAGE CARPORT [i RETAINING WALL ROCKERY o F RE SPRINKLER FIRE ALARM OWE OfA*E,-BUSINE,%S OR ACTIVITY) EXPLAIN: PERMIT EXPIRES '7 O'� j L. USE PERMIIT ZONEP= NUMBER cx� JOB 2,1 C) TU�-� NUeEIAZ) ADDRESS PLAT NAME/SUBDIVISION NO. T NO. LID NO. LIDFEE $ TESCIR Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerrrAl Required street Ute Pernik Roq'd EXISTING — PROPOSED-- Inspection Required Side*&Lk Required REQUIRED DEDICATION— FT Underground Witing required METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED I (j YES113 —LOA REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE BY DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINEORADBI I INSPECTION BOND REQ'D/ POSTED u- iosc>-,31 13, 0wo SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP NIV LOT COVERA6E ' REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.. ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR NUMBER NUMBER OF I I RITICAL OF DWELLING kj AREAS NUMBER STORIES UNITS M I � I A I 1�erlaAl (1) e&f-J-roVf1 ';-)7% y C-A a ri .6 ti / 9 F'-v M0 (w o a,,-i r te d C) ^--r HEAT SOURCE GLAZING % L T SLOPE% P. cleA = — VESTED DATE PLAN CHECK NO: THIS PERMIT AUTHORIZES ONLY THE WORK NOfED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC DOMAIN JCURUS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPUCATION: ISO DAYS PERMIT UMM 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 NATURE, 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 CITY'S 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 WORKMENS COMPENSATION INSURANCE AND RCW 18.27. DATE SIGNED ) —1 —�_3 z PARKING LOT AREA I P NING REVIEWED BY REQ'D ED (4 PROVID CHECKED BY TYPt,0ft9ONSTROCTION OCCUPANT V__ G R 0 UP OCCUPANT SPECIAL INSPECTION JAREA REQUIRED]gyES I U LOAD REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REG'D $'d (4 5, E Description FEE Description FEE Plan Check State Surcharge EW Building Permit City Surcharge J!�" Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # 72 CALL FOR INSPECTION (425) 771-0220 APPLICATION AP ROVAL This application is not a permit until signed by the Building Official or histher Deputy: and Fees are paid. and receipt is acknowledged In spa provided. O�FFICIAIGN E TTE RELE B DATE ATTENTION 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- 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 M C M 0 0 0 C � K M z 0 _n n M 0 0 6 Fn C2 M0 z z 0 M FINAL PROJECT APPROVAL FORM TO: si Date ocapryl.doc.l:temp-bldg:formslO/01 z 9 0 m :i 9 3m: c rn 0 0 80 c -4 x X M M Z 10-4 c 0 -n n M m 0 0 0 M C (j) m Cl) M 0 Z z z 0 m E� DATE RECEIVED �PERMIT EXPIRES CITY OF EDMONDS USE PERMIT ZONE 00 So� NUMBER CONSTRUCTION PERMIT APPLICATION JOB su ADDRESS 0 0 ER NAMEINAME OF BUSINESS PLAT NAME/SUBDIVISIO�.V�_T�140. LID NO. MAILING ADDRE as 1, 9 0 /V. r--- pl-re ^'6� C.3 LID FEE $ TESCP Appro"d PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PeffWt Requ Wed CITY I TELEPHONE I Street Uss, Permit Req'd EXISTING - PROPOSED Inspection Required Side*ztk Required REQUIRED DEDICATION- FT UndeWound Wring required NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED U YES NO A V ADDRESS 9 e REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP ��,�ITELEPHONE A I;L,53 Men NAME CBL# IL0 1 I �0"M ENGINEERING REVIEWED BY DATE DRESS P 0 FIRE REVIEWED BY DATE ZI ELEPHONE C9 f If STATE LICENSE NUMBER EXPIRATION CHECKE15 Y VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND POSTED REQ�Dj 1C3YES^O$ (2_(_>-1C4ao-'31 --s-003", PROPERTY TAX ACCOUNT PARCEL NO. SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP NEW PLUMBING MECH RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR ADDMOA.":.'; OMMERCLAIL 0 C=NCE OFji: >ec C OF USE 0 z . PARKING LOT AREA NING REVIEWED,BY- DATI t M�REMODEL 1110 MUjTIFAMI4 E] SIGN RECVD I PROVIDED IP IL x 44 Nio FENCE X Fr) 0 REPAIR GRADING CYDS 11 DEMOLISIf [:],JANK OTHER =a 0 GARAGE RETAININbWALL [3 F RE SPRINKLER CARPORT ROCKERY. FIRE ALARM G tY% UWE 0 E. BUSINE OR ACTIVITYII EXPLAIN: '� :A;;- CHECKED BY TYPE OCCUPANT tjg� JS f, C _ _9WNjTRP!1ON GROUP Vor It C61TICAL NUMBER NUM R OF C' AREAS OF DWELLING _6L STORIES UNITS NUMBER .000 JAREA OCCUPANT SPECIAL INSPECTION A01 REQUIRED YES I U t, b LOAD DE35MM!DO I REMARKS Ab PROGRESS INSPECTIONS PER LIBC 11081FINAL INSPECTION RE(V0 ..001 ��Aq-u a t7 13,, F, VALUATION LAU /61 Kooppir 114c, 14W 1W c4, 51 Description FEE Description FEE Plan Check State Surcharge==5V HEAT SOURCE4 GWMG % L�T SLOPE % =ho ag-fe'-� A14 6,5e.- Building Permit City Surcharge _A1 PLAN CHECK NO: VESTED DATE at, Ir' Plumbing Mechanical I PERMIT AUTHORIZES ONViTtiE, WORK NOTED. THIS PERMIT COVERS WO RKTO THIS t: BE DONFIPN PRIVATE PROPEMY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (OURS5. SIDEWALKS, DWEVAYS. MARQUEES, ETC.) VALL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 100 DAYS 18STARTEDWIT"IN ISODAYS PERIM11T LIKILM I YEAR - PROVIDED XO% Engr. Inspection SEE BACKOF PINK PERU Fd MOREINFORMATION 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESO RS Fire Review Plan Chk. Deposit _C U- 'j — IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF ffo��_ EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Firo Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE FROM THE ISSUANCE Landscapelnsp. Total Amt. Due r7vo;5z DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." -;7foo Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GWEN 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 This application Is not a permit until signed by the 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 FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and receipt is acknowiedgod In spa provided. WORKMEN'S COMPENSATION INSUELANCE AND RCW 18.27. TE sMWe IA03 DATE SIGNED %425) 00� ) —1 —)`_3 ;A& —1 771-0220 RELE By . V DATE ATTENTION Off 1 3 y IT IS UNLAWFUL TO USE OR OCCUPYLA BUILDING OR STRUCTURE UNTIL AMNAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR dAIE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES z 9 0 M =i:% ui � a M C ing 40 0 C M z 0 _n n M ui C z 0 4 0 M