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20030151.pdf4 . DATE RECEIVN I CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS Ck kl-ko W R 19- -,,w CITY ZIP TELEPHONELZ�OS-G56-1950 L-K C)SVI&C. Oe c(1056- I iz_� XITLITAT:i ADDRESS CITY ZIP NAME ADDRESS CITY ZIP L't 0 W VI-M 32d� STATE LICENSE NUMBER CL\1 �A PP\rL t 70 0 11 PROPERTY TAX ACCOUNT PARCEL NO. TELEPHONE TELEPHONE 0 NEW 0 RESIDENTIAL 0 ADDITION X-COMMERCIAL XREMODEL 0 APARTMENT 0 REPAIR 0 GRADING CYDS 0 DEMOLISH 0 TANK o GARAGE CARPORT 0 RETAINING WALL onr-lecov (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMUCH VIP' OF '4 DWELLING STORIESSf 1) r�l UNITS DESCRIBE WORK TO BE DONE HEAT SOURCE 64tirm- �LAN CHECK NO: 0 GLAZING % .-.�o 4:7 3- LUMBINGCMECH� ci COMPLIANCE OR CHANGE OF USE F1 SIGN FENCE 0 ( _X FT) 0 OTHER M RENEWAL CRITICAL AREAS NUMBER .006� LOT SLOPE % DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 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 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 REOUIREMENTOF ANY CITY ORDINANCE NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." I HEREBY 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 LABOO�.�F THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSAI40ffTNWRANqE AND RCW 18.27. DATE SIGNED O:YS�03 [PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS 'aae' J51 w PLAT NAME/SUBDIVISION NO. LOT NO. LID N LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Permit Required Street Use Permli Req'd EXISTING - PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION- FT urldorground Wiring required METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED YES 1:1 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE GAS PIPE TEST MUST BE OBSEHVEnY CITY INSPECTOR ENGINEERING nr- mxPPii;nREVIEWED/DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE d� ADB9 INSPECTION I BOND RECI'iD POSTED Ile E3 YES 0 SEPA REVIEW SIGN AREA HEIGrIT COMPLETE I EX7 ALLOWED PROPOSED ALLOWED , PROPOSED /VA EXP I �� LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (F1% ALLOWED P.RQPOSED FRONT SIDE REAR FRONT L/R SIDE REAR "h 6h6=4jee I PARKING KOT AREA PLANNING REVIEWED BY DATE REQ'ID I PROVIDED I I 1. CHEC)<ED BY TYPE OM SPECIAL INSPECTOR JAREA REQUIRED [:] YES AlTMTION 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 51'98 unheated PLAN CHECK FEE BUILDING PLUMBING MECHANICAL GRADINGIFILL 4ftTE SURCHARGE ENG. REVIEW FEES ENG. INSPECTION FEE LANDSCAPING INSPECTION FEE R PLAN CHECK DEPOSIT R TOTAL AMOUNT DUE '0 OCCUPANT OCCUPANT LOAD VALUATION I FEE APPLICATION APPROVAL This application is not a permit until signad by the CALL Building Official or histhor Deputy: and Foos are paid. and FOR INSPECTION receipt is acknowledged in space provided. 0 L IGNA E PAT& (425) j e7l It A 5 / Qj %ff 4U 771-0220 �DR 16"ASgABi' DATE EXT 333 771-0221 0 RIOINAL RIGINAL - FILE YILLOW - INSPECTOR FAX PINK - OWNER GOLD - ASSESSOR a z E w z z a z uj W M M. a z I a ------------- fs*NAT�E RECEIV Rlah 'N.1144 PERMIT EX S PIRE Lj CITY OF EDMONDS CONSTRUCTION PERMIT APPLICP�TION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS CITY ZIP NAME ADDRESS CITY ZIP ITELEPHONE NAME �Y,yi� ADDRESS P—C-> _R1 CITY ZIP I TELEPHONE USE ZONE PERMIT NUMBEROT(�� (A5 JOB ADDRESS -5 1 w r3 SUITE/APT# d PLAT NAM E/SUBDI VISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0 Rw Permit Required E3 Street Use Permit Req'd 0 EXISTING - PROPOSED Inspection Required 0 Z,-(:;56-19S0 Sidewalk Required 0 STATE LICENSE NUMBER EXPIRATION DATE RRECKE M PfAT- C70 01 1-2.G-04 -4 PROPERTY TAX ACCOUNT PARCEL NO. C3 NEW C] RESIDENTIAL �<PLUMBING�l �MECH ADDITION COMMERCIAL COMPLIANCE OR X_ . I CHANGE OF USE REMODEL APARTMENT SIGN 0.�AEPAIFI GRADING o FENCE CYDS FT) 0 69MbLISH OTHER 0 TA�NK 0 GARAGE C] RETAININGWALL RENEWAL z CARPORT ROCKER)t_ r- (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: w a 101 NUMBER OF NUMbER OF WELLIN D 0 CRITICAL AREAS 0 STORIESS UNITS -NUMBER nFqCRIREWORKTOBE DONE REQUIRED DEDICATION- FT Underground Wiring required �1.1 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NO 0 ,u REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE a z D!U& TECTut iew BE w ENGINEERING Lou. nuurr i cu REVIEWED/DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE " ADB V INSPECTION BOND 12!r REO'D POSTED C3 Z��O "7 42 1 SEPA REVIEW SIGN AREA HEIMT COMPLETE EXEM ALLOWED PROPOSED ALLOWED , PROPOSED EXP 1 7 1 __ LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fd ALLOWED PRnPnqFD FRONT SIDE REAR FRONT UR SIDE REAR PARKING REO'D I PROVIDED 'AREA I PLANNING REVIEWED BY DATE I t_Fa1>C_ ". I 1� . f 'I CHECKED BY I TYPE O?y N 0 N SPECIAL INSPECTOR JAREA REQUIRED C] YES REMARKS 7 PR _RF!Ng§CLCTIO 7 Type B or L "'luired on rm CODE OCCUPANT ,-Yn"ROUP OCCUPANT LOAD z 0 0 m PER LIBC 1081FINAL INSPECTION REO'Cli VALUATION FEE PLAN CHECK FEE 19 1 1 HEAT SOURCE GLAZING % LOT SLOPE % BUILDING I 6LI PLAN CHECK NO* VESTED DATE — 0 (V 9- (-) PLUMBING -_!:� MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. 0. MWE SURCHARGE PERMIT APPLICATION: ISO DAYS 0. PERMIT LIMIT* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE11NIFORMATION S. ISIS A�D SUCCESORS 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIR -iilG ENO. ASPECTION FtE IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING 0 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE CC ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY SHALL NOT BE RECEIPT FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT PLAN CHECK DEPOSIT DEEMED TO MODIFY, WAIVE OR REDUCE A NY REQUIREMENT OF, ANY CITY ORDINANCE 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* RECj9Tj C��,j mi sese-sesse TOTALAMOUNTDUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIbATION; TRAT THE INFORMATION GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY A&HORIZED AGENT OF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This applicali on is not a permit until alltned by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 6ulicling Official or his/her Deputy: and Fees are Paid, and IN VIOLATION OF THE LABOBXCMVF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENS�;�URANtE AND ACW 18.27. 0 SIG Er PATE 3b Sl E 10"I�NR 01� AGENT) DATE SIGNED (425) %7/771 A U4V1X44_WZ 771-0220 S BY DATE TION EXT 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 1 A FINAO INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE' YI!LLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR 5t98 ------------- IIIIIIS