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20030171.pdfte DATE RECEIVED s PERMIT EXPIjE CITY OF EDMONDS bSE PERMIT ZONE NUMBERA4�5-e�/Z/ CONSTRUCTION PERMIT APPLICATION JOB ADDRESS OWNER EIAME OF BUSINESS J. 77 �__ 1, - 4�_� , , -, d /_ L(!__ PLAT NAME/SUBDIVISION NO. I.Of NO. LID NO. I , - ( _ .,, - - 15 MAILIWADDRESV LID FEE S — - , - 3 .3 jESCP ApprOvsd PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pefffit Required Use Parmh Req'd CITY ZIP TELEPHONE Strati EXISTING — PROPOSED Impaction Required sidewalk Required REQUIRED DEDICATION Underlyound FT Wiring required 13 N#AE METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED I YESM NO C3 ADDhESVJ 0 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE C TELEPHONE zip TZE 7q 1"NAME CBL# kL-- J A ( ENGINEERING REVIEWED BY DATE CC ADDRE a/ Zsew 3 41. FIRE REVIEWED BY DATE US CC CITY ZIP TELEPHONE rL 7d AIANCE OR CU SHORELINE OR AOB# INSPECTION BOND STAIE, LICENSE NUMBER EXPIRATION CHECKED EIV REO'D POSTED 113YEs Is rMq ct ONG BEIRA REVIEW SIGN AREA HEIGHT PIROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I Ea -NEW RESIDENTIAL [B,.Pt!1W1NG MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFISIDE REAR COMPLIANCE OR ADDITION 0-`6QMMERCIAL 1:1 OF USE z CHANGE DATE PARKING LOT AREA PLANNING REVIEWED BY REMODEL MULTIFAMILY 0 SIGN RECfD PROVIDED GRADING FENCE X 13 REPAIR CYDS FT) REMARKS DEMOLISH OTHER 13 TANK ciGARAGE 0 RETAINING WALL FIRE SPRINKLER ALARM CARPORT ROCKERY FIRE "VPj BE. BUSINESS ORA CHECKED BY OF CONSTRUCMION ICODE OCCUPANT 2 ITYPE GROUP ;S Pli I,\/ 7 CRITICAL NUMBER/ NUMBE III AREAS OF DWELLIVG SPECIAL INSPECTION OCCUPANf STORIES UNITS NUMBER JAREA LOAD REQUIRED 0 YES DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER USC 1108/fINAL INSPECTION REG-0. A L VALUATION # $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge 6- PLAN CHECK N VESTED DATE Plumbing - 1 2::L 1 Mechanical THIS PERMrT AUTHORIZES ONLY THE W0R_KN THIS PERMIT COVERS WORK TO MoIc- tz BE DONE ON PRIVNIE PROK-11- - NONIHIEPUBLIC Grading 2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPLICATION: 180DAYS CL. PERMIT LIMM 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 SUCCESORS 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 HE Landscapelnsp. Total Amt. Due C 10 5 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE L_ 0 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- 1.f) ,I Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATI ON 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- This applicaUon Is not a permit until signed by the CALL 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 Building official or his/her Deputy: and Foes are paid, and FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 0 — OFFICIALS SIGNATURE ATE T TUR OWNER A DATE SIGr U RAO) / 771-0220 DA1%' RErLEA�By ATTENtldff EXT 1333 - ZJA2 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 - INSF CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING "DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION PERM'IT'6PIRES USE PERMIT ZONE yj NUMBER J013 SUL& ADDRESS Xj OWNER E OF BU7E L e— PLAT NAME/SUBDIVISION NO. Lot NO. LID NO. MAILINIVADDREOV LID FEE $ 140,01 y TESCP APproved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Porn* Required CITY ZIP TELEPHONE EXISTING — PROPOSED suset Use Permit 1wed Inspecilon Required Sidewslic Required ?g;l, ig& 0 REQUIRED DEDICATION— FT UndergrouW VAringrequired! cl N#AE METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED I YES 13 NO 13 ADONESO U REMARKS L67AI S. —J�Ieoo NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE _2! 5 7 C ZIP JTE�LEPHOINE UW�..4 NAME BL# ic z ENGINEERING REVIEWED BY DATE CC ADDREYP z CrTydF zip TELEPHONE FIRE REVIEWED BY DATE LU 0 g 91 7# .7 ME ASTA* LJCENSE NUMBER EXPIRATION CHcriecn RV TE VARIANCE OR Cu SHORELINE OR ADBN VAR' INSPECTION BOND REO'D POSTED 113YES ITI D Pr L � 8M SEPA REVIEW SIGN AREA 13NO IS HEIGHT PhOPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 74 --- 00 4: � 77 4 EXP , ITI C: LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FEL RESIDENTIAL [3,9tWB_1NG / MECH SIDE REAR FRONT URSIDE REAR COMPLIANCE OR a ADDITION 0-rOMMERCIAL CHANCE OF USE ALLOWED PROPOSED FRONT C PARKING PLANNING REVIEWED BY DATE M L[:]REMODEL MULTIFAMILY SIGN REQ`D PROVIDED 916 ITI I � I " I 10 REPAIR 0 GRADING 0 FENCE CYDS X FT) REMARKS z OTHER .DEMOLISH TANK 12, 11 "E CA RETAININGWALL F RE SPRINKLER CARPORT 0 ROCKERY FIRE ALARM 0 n R BUSWtIESS 00 ACTIV CHECKED BY TYPg OF. CON& 06TION CODE OCCUPAk GROUP '?I! -Al W ITI ITI NUMBERRfiP CII NUMBENR liTICAL OF WELLI AREAS SPECIAL INSPECTIO EA* 0 STORI NITS NUMBER ES U REQUIRED YESN� r LOAD 0 Fn DESCRIBE WORK TO BE DONE I= (h REMARKS C0 A"L A PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D 0 VALUATION s Description FEE�, Description FEE ca z ;s 'Plan Cheek State Surcharge 0 HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City S urcharge 0 ITI VESTED DATE PLAN CHECK N044,, Plumbing Mechanical AV THIS P R; THIS PERMIT COVERS WORK TO wc6c ,E=AUTHORIZE ON PRIVATE Ly. -ON ON ME PUBLIC Grading DOMAIN (CURS'S, SIDEWALKS, DRIVEWAYS, MARQUEES ETC.) WILL REQUIRE t: SEPARATE PERM,J�SION. 2 Engr. Review PERMrr APPLICATIOdItill DAYS 06 PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WTFHIN 180 DAYS Ennr. Insnection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, 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 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES , ANDAGENTS FROM ANY AND Fire Inspection Receipt # 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 Landscapelnsp. Total Amt. Duo W-1 zj NOR LIMIT IN ANY WAY THE CrTY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Recording Fee Receipt # - I HEREBY ACKNOWLEDGE THAT I HAVE REM 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 This application Is not a permit until signed by the TION; AND L4 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 STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In sLmcq provided. WORKMEIT$ COMPEN RAN E AND RCW 18.27. bFFICIALS SIGNATURE ATE RE OWNER AGE DATE SIG D MSn0(J1_11 771-0220' - f RELE BY C D ATTENfIdIf M 1333 —91710 IT IS UNLAWFOL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL , r, A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW - INSPE�Toi( CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES G REEN ACCOUNTING