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20030143.pdf0 DATE RECEIVED CITY OF EDMONDS ' CONSTRUCTION PERMIT APPLICATION OWNER NAMEIN�_Ji_E OF �B USINESS MAILING ADDRESS I - $I& C; 2c; 2 CITY ZIP TELEPHONE NAME ADDRESS CITY ZIP ITELEPHONE ---[PERMIT EXPIRES USE PERMIT ZONE IC,5,7 NUMBER ADDRESS SUITEb r-0, 1-9 1-10 PLAT NAME/SUBDIVISION NOT LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Par. Rq.kad Street Use Poffnit Roq'd EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED (3 YES 13 NO 13 z 15 REMARKS I OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE I CBL ENGINEERING REVIEWED BY DATE QC1NAME ADDRESS 0 'TY FIRE REVIEWED BY DATE Z�1� TEL PHONE VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND E CHEckEF B REO'D POSTED I 113YEs jNDAT AML-z dyli 13NO $ __90 — — . 4 PROPERTY TAX ACCOUNT PARCEL 1 01 SEPA REVIEW SIGN AREA HEIGHT co PROPOSED ALLOWED M LETE EXEMPT ALLOWED OPOSED PR 0 9 I EXP NEW RESIDENTIAL PWMBING/MECH x LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR ADDITION COMMERCIAL [3 COMPLIANCE OR CHANGE OF USE REMODEL 0 MULTIFAMILY SIGN PARKING LOT AREA PLANNING REVIEWED BY DATE REOD PROVIDED F13 MARSHAL GRADING FENCE [3 REPAIR CYDS X Fri REMARKS MUST BE PRESENT FOR DEMOLISH K OTHER TANK FILL, REMOVAL, OR CAP GARAGE RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, 6 S OR ACTIVITY) EXPLAIN: CHECKED BY OF CONSTRUCTION CODE OCCUPANT ITYPE j?') GROUP UMBEP 77 NUMBER OF CRITICAL OF WELLING AR S STORIES S NUA UNIT EMBER 0 AREA SPECIAL lNSPECTINfW OCCUPANT LOAD REQUIRED 0 YES DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD [VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge 6-- PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMfT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS Is. PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPILICAUL ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 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 ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- a­sasess Recording Fee Receipt # U2 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 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit unfit signed by the CALL TiON; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and IN VIOLATION OF THE LABOR CODE OF THE STAIE OFTINGTON RELATING TO FOR INSPECTION 1pt Is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE Al 9W 18.27. OF SIGNATLIA RE DATE SIGNATU ANED tz4rvtp�� A (425) 00 771-022 RELEASED BY 77TEaTION 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- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE - YELLOW - INSPECTOR PINK -OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING FINAL PROJECT APPROVAL FORM TO: DATE: MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION z 9 0 m :q =n- M M 0 --lo 0 C= -4 r. mm M Z 0-1 M m a 0 0 M M 0 z z 3� co) z 9 0 m 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Si ocaprvi.doc.l:tmp:bldg:formsIO/Ol rl j,�DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS I - MAILING ADDRESS C;24=�' CITY A ZIP ITELEPHONE NAME ADDRESS CITY ZIP I ITELEPHONE 'N',O't I PERMIT E)(PIRES USE ZONE PERMIT NUMBER JOB S ADDRESS PLAT NAME/SUBDIVISION NO.' LOT NO, LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP App'=. W Prmit R St" Use Permit Rsr�d EXISTING — PROPOSED inspection Requited 51dowarA Raquired REQUIRED DEDICATION— FT UnftwmxW I vvmg r Wed 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED ES13 NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE NAME oe:. CBL ENGINEERING REVIEWED BY DATE ADDRESS DATE FIRE REVIEWED BY cl NE TY ij+;�PHO ir -151-101160-11400� -- - VARIANCE OR Cu SHORELINEORADBN INSPECTION BOND LICENSE NUMjE'? EXPIRATION DATE CHECKED BT REO'D POSTED [3YEs 13NO $ SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED d , , , - - EXP NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) FRONT SIDE REAR FRONT LIRSIDE REAR 14 ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE z PARKING LOT AREA PLANNING REVIEWED �Y DATE REMODEL MULTIFAMILY 0 SIGN REOD PROVIDED I I REPAIR GRADING [:] FENCE X CYDS Fn REMARKS FIRE MARSHAL — DEMOLISH ;;�TANK 0 OTHER MUST BE PRESENT FOR GARAGE o RETAINING WALL FIRE SPRINKLER MR FILL, REMOVAL, OR CAP CARPORT ROCKERY FIRE ALARM ME OF USE, SUSlW OR ACTIVITY) EXPLAIN: mommommommommu� . CHECKED BY TYPE OF C014STRUCTI ION coj)g— OCCUPANT I 'Zl'—I T7 GROUP a NUMBER NUMBER OF CRITICAL IN AREAS OF D ELLING AREA OCCUPANT SPECIAL INSPECTION AREA f STOMES UNITS NUMBER_ REQUIRED [:] YES LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REG'D Aft A06 M 0111111KIIII MMMIM 16 VALUATION IMIE $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE T—­61LAZING % 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 DOME ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUBLIC Grading 2 DOMAIN (CUIRRS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 3 t: SEPARATE PERMISSION. Engr. Review PERMITAPPLIrATION: IGO DAYS PERMIT UMM I YEAR -PROVIDED WORK 18 STAITTE WITHIN ISODAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF Or HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON. IT$ OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, AWSING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Due Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CTIVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION .' itt. Recording Fee Receipt I ��j 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 CRY 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;7HINGTON RELATING TO FOR INSPECTION Building Officiall or h1aftr Deputy: and Fees are paid, and Aec ptis cknowiedgod In space provided. WORKMENS COMPENSATION INSURANCE 18.27. OF BIG AT E' DATE SIGNATURE 771-0220 RELEASED BY DATE ATTENTION EXT 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 I =