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20030150.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER 14AM OF BUS[ SS CITY ADDRESS CITY ADDRESS CITY .o0o ZIP ZIP I TELEPHONE 7 66E ZONE JOB ADDRESS PERMIT EXPIRES PERMIT NUMBER old I 3u-t'-� is-0 PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE $ TESCP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required Street Use Permit R*q'd EXISTING — PROPOSED Inspection Required 13 Sidewalk Required 13 REQUIRED DEDICATION— FT underground Wiring required C3 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES 13 NO 13 Le REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE H rinE wimnal"IML 1CB1 N ENGINEERING REWIWX BE RNMNT FOM DATE TANK FILL. REMOVAL. OR CAP FIRE REVIEWED BY DATE ZIP TELEPHONE NEW 0 RESIDENTIAL 0 ADDITION 0 COMMERCIAL REMODEL 1:1 MULTIFAMILY REPAIR 1:1 GRADING CYDS 0 DEMOLISH TANK #[—:i GARAGE CARPORT RETAJNING WALL ROCKERY (TYPE OF USE, BUSINESS OR LAIN: NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE PLUMBING / MECH COMPLIANCE OR CHANGE OF USE SIGN EFENCE ] ( — X—Fr) [:] OTHER 0 FIRE SPRINKLER FIRE ALARM VARIANCE OR CU SHORELINE OR ADBN INSPECTION 1$ BOND REQ'D POSTED 1C3YEs ONO SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED , PROPOSED I ALLOWED , PROPOSED LOT COVERAGE I REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR PARKING LOT AREA I PLANNING REVIEWED BY DATE REO'D I I CHECKED BY ITYPE DNS 'NUCTr CRITICAL tj �n rE A AREAS SPECIAL INSPECTION AREA NUMBER REQUIRED [:] YES REMARKS PROGRESS INSPECTIONS PER USC I GLAZING % LOT SLOPE % HEAT SOURCE PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE 014 PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC-) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: ISODAYS PERMIT LIMM 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 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 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; 714AT 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 COV&ff THE sTj?rE OF W HINGTON RELATING TO WORKMEN'S COMPEJOSAUTOLUSAIRAW All BCW 18.2 7 Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscapeinsp. Recording Fee OCCUPANT GROUP OCCUPANT LOAD W Ir Ir 2 INSPECTION REaD FEE Description FEE State Surcharge Wo — lCity Surcharge r� -- CALL R INSPECTION IA-0 ) J_.5 771-0220 EXT 1333 Plan Chk. Deposit Receipt # Total Amt. Due Receipt # APPLICATION APPROVAL IpplicaUon Is not a permit Until signed by the 9 1 or his/her Deputy: and Fees are paid, and 39"cls acknowledged in space provided. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDAG 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 by DATE ORIGINAL -FILE YELLOW -INSPECTOR PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING MEMO TO: FINAL PROJECT APPROVAL FORM PERMIT COORDINATOR, BUILDING DIVISION TO: DATE: z 9 0 m :;:R OM c ma 0 80 c M MZ 10 -f CE cn 0 -n m M 0 0 0 M C M 0 Z X z z 0 m GRANT FINAL PROJECT APPROVAL RE -INSPECTED OUTSTANDING ISSUES Si ocaprvl.doc.l:temp:bldg:fonnsIO/OI nrv- r. t 7— .C�-DATE RECEIVED U I 14 PERMIT EXPIRES CITY OF EDMONDS USE ZONE PERMIT NUMBER CONSTRUCTION PERMIT APPLICATION JOB ADDRESS W- I I S!0 OWNER NAME/lk E OF BUS�WSS �g PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 15 MAILING ADDRESS 1 ze?K LID FEE $ TESCP Ap PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pem"t= ad Street Use Permit RWd CITY ZIP ITELEPHONE EXISTING — PROPOSED— Inspection Required Sidews* Required REQUIRED DEDICATION— FT UnderWound wmg required 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 1 1 YESE3 NO 13 1 N ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE MHE MA PSHAL. In'T. CITY ZIP ONE A.4.1 __ - - TAN latz__�"NESENT F0Fj NAME,.,j 1 11-fWVVAL, OR ENGINEERING REVIEWED BY DATE ADDRESS FIRE REVIEWED BY DATE CITY ZIP TELEPHONE rL 44 9V_ 'ERPIRkTICIN E .-LICEWSt NUM6 C VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REQ'D POSTED -A OyEs UNO 4 PROPERTY TAX ACCOUNT PARCEL NO. SEPA REVIEW COMPLETE EXEMPT SIGN AREA HEIGHT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , NEW RESIDENTIAL El PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SET87AKS (Fr.) FRONT REAR FRONT LIRSIDE REAR ALLOWED PROPOSED SIDE COMPLIANCE OR 0 ADDITION COMMERCIAL 0 CHANGE OF USE z REMODEL muLnFAmiLy SIGN PARKING LOT AREA I PLANNING REVIEWED BY DATE REDID I PROVIDED REPAIR GRADING FENCE X CYDS FT) REMARKS DEMOLISH TANK OTHER GARAGE RETAINING WALL F RE SPRINKLER FIRE ALARM CARPORT ROCKERY MIND (TYPE OF USE, BUSINESS OR A3T� IN: CHECKED BY ITYPE ONST U OCCUPANT . f OR NUMBER NUMBER OF CRITICAL OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT LOAD STORIES UNITS NUMBER REQUIRED [] YES DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REaD VALUATION Afflill ETEn kviv LUC 9* $ Description FEE Description FEE Plan Check State Surcharge I HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge CK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUITHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC X Grading MAIN RE :3 00 (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUI SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180DAYS CL PERMIT UlArP 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 SUCCESCIRS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY; DEFEND 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 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 Landscapeinsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION., # Recording Fee Receipt I I HERE13Y 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 T pplicatlo IsnotapermitunII15Igned by the nhls1hw TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Bull 9 1 or Deputy: and Fees we paid, and M, IN VIOLATION OF THE LAQOR CODISOF THE STATE OF W 'HINGTON RELATING TO FOR INSPECTION ir a tin acknovAedgod In space peovided. WORKMEN'S C P 18.27. � ' OFFI IGNA RE DATE at DATE JSIGNEO' IA-05) %—TK" 1 *,.-:p z 771-0220 'Prizza 3k 3 mdo—, 92-- REL S BY DATE ATTEAAON"�,-`� /GOR EXT 1333 IT IS UNLAWFUL TO USE OR OCCUP A BUILDI 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 ORIGINAL -FILE YELLOW. INSPECTOR PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING -_--------- L