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20030181.pdfM DATE CITY OF EDMONDS " CONSTRUCTION PERMIT APPLICATION RR NAMEINAME OF BUSINESS I CITY - - , Lzed -_ f� NAME ADDRESS CITY NAME ADDRESS 7 0 CITY STATE LICENSE NUMBER zoy_�� a PROPj,PTY TAX ACCOYNT PARCEL NEW ADDITION REMODEL REPAIR WEMOLISH oGARA13E CARPORT (TYPE OF USE. I NUMBER OF STORIES Wo�DESCRIBE I ZIP ZIP I TELEPHONE RESIDENTIAL COMMERCIAL 'Oet��ULIIFAMILY GRADING CYDS TANK RETAININGWALL ROCKERY �S OR ACTIVITY) EXPLAIN: .0 -2/f - N PERMIT EXPIRES mxs� USE PERMIT ZONE NUMBER JOB "FJAFT# ADDRES PLAT NAME/SUBDIVISION NO. 77"' LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appmv#d AW ParrM Required Street Use Poffnh Roqd EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Undergitourid Whing required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES13 — NO 13 REMARKS 4NER/CONLRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE _0 - - .4 'e ON - ENGINEERING REVIEWED BY FIRE REVIEWED BY DATE W r6 n DATE T E V VARIANCE OR Cu A R 'A N C E SHORELINE OR ADB# INSPECTION BOND REO'D 1,13YEs POSTED ONO $ E P SEPA REVIEW 8 A SIGN AREA HEIGHT C M L E COMPLETE 0 P ET EXEMPT ALLOWED PROPOSED AL LOWED PROPOSED EXP X P , , , IN r H PLUMBING/mECH U M B M 1 rC LOT CC LOT COVERAGE REQUIRED SETBACKS (FT.)., PROPOSED SETBACKS (Fr.) ALL OWED ALLOWED PROPOSED FRONT SIDE REAR FRO NT UR SIDE REAR CE 0 R oCOMPLIANCE OR M P L I A N .: USE CHANGE OF USE G E 0 F PARKING I LOT AREA PLANNING REVIEWED BY DATE SIGN REO'D PROVIDED FENCE X FT) REMARKS OTHER FIRE SPRINKLER FIRE ALARM I NUMBER OF CRITICAL""ll DWELLING AREAS 110/� UNITS NUMBER TO BE DONE CHECKED BY I TYPE OF CIONSTRUCTION N� P coo OCCU;A GROUPC/A 1, SPECIAL INSPECTION REQUIRED [3 YES JAREA OCCUPANT f LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D —9 j!�wpcle 1&"&h"foXA1ezW /H ms��- I o+vfs ig ttle- "migge d VALUATION $ Descirliption FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % I LOT SLOPE % Building P . ermit City Surcharge �__ PLAN CHECK NO: VESTED DATE Plumbing Mechanical TINIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO k: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 23 Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION: 1180DAYS PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMff 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 BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # 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 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 Building Otficial or his/tier Deputy: and Fees are paid, and IN VIOLATION OF THE LABODA"E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'j=19nNSUrNCE AND RCW 18.27. LS SIGNPTURE DATE SIGNATURE 0 GE (425) �V 771-0220 16ATE ATTENTION EXT 1333 IT IS UNLAWFUL TASE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW-INSPECTOPI CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 1 0 m =i :-n U5 :0 0 M c m 0 80 c -4 r. 3: M M Z Cl) 0 -n n m M 0 Ui 0 0 Fn C co) r. CO) M 0 z z Cl) z 0 m I I CITYOF EDMONDS CONSTRUCTION PERMIT APPLICATION IR NAME/NAM OF BUSINESS .0 . A j CITY ZIP TELEPHONE 4v NAME ADDRESS I 6&u; PERMIT EXPIRES ZEA USE PERMIT ZONE 114. NUMBER JOB ADDRES�s,u,a i r Q I I nvAPT# A_ A PLAT NAME/SUBDIVISION NO. - -- LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESUP Appro"d Lj RW Perrrit Rewww Sum We Parmft FW0 EXISTING — PROPOSED Wappetion Required SkMwalk Requirod REQUIRED DEDICATION— FT uWkW&x4 wworequitw METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES C3 NO 13 REMARKS 02ER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE CITY ZIP TELEPHONE f CIA—V r coor S.0,7_1 far r aw., NAME LN C) e171'_"1V1r,E ENGINEERING REVIEWED BY WE ADDRESS 7�_4 '4�011 -7 Ll FIRE REVIEWED BY DATE Lu CITY ZIP ONE cc VARIANCE OR CU SHORELINE OR ADB# INSPECTION—i BOND STATE LICENSE NUMBER EXPIRATIqN DATE' Y REO'D POSTED 42 13YEs ONO $ Llzleg I M SEPA REVIEW SIGN AREA HEIGHT PROMP TAX PARCEL COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 7,COLINT EXP I , I NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FR04T LIR SIDE REAR 0 ADDITION' COMMERCL4kL COMPLIANCE OR CHANGE OF USE PARKING LOT AREA I PLANNING REVIEWED BY DATE REMODEL �&MULTIFAMILY SIGN REO`O I PROVIDED [3 GRADING [3 RNCE X RE.PAIR CYDS REMARKS OTHER WEMOLISH TANK [3GASME [3 RETAININGWALL [3 FIRE SPRINKLER FIRE ALARM CARPORT ROCKERY -A (TYPE OF USE. BUS I ACTIMY) EXPLAIN: CHECKED BY OF OCCUPA 95 ITYPE I .0t, GROU �NSTRUCTION g�z� T NUMBER NUMBER OF 'AL CRITICAL N J�� Ag 'OF DWELLING Zj AREAS SPECIAL INSPECTION JAREA OCCUPANT STORIES UNITS IER REQUIRED [:] YES LOAD DESCRIBE WORK TO BE DONE 777�" REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION R EGVD . &6m" AA v be- Xemp VALUAnON r $ Description FEE Description FEE Plan Check State Surcharge HEAT SOUR CE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRTVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURDS, SIDEWAUCS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMrrAPPUCAtON: 100DAYS PERMIT LIMM I YEAR - PROVIDED W RK 18 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 In6pecilon Receipt III ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due 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.' Recording Fee Receipt # I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL, GIVEN IS CORRECr 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 pemit until signed by the TION; A14D IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building OlPcIW or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOI�-CI04E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in spare provided. WORKMEN`I3C"SAT1ynNSUqhNCE AND RCW 18.27. DATE 81 N TURE _� �ALS OF SIGNATURE 0 GE DATE SIONED IMT. 41) 771-0220 15ATE ATTENTION EXT 1333 TWIT IS UNLAWFUL sE 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