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20030195.pdfM DATE R CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWR�R NAMEINAME OF BUSIN&SS _ r )ge 16� - n I MAILING ADDRESS I Uvalif NAME ADDRESS CITY ADDRESS gd— i CITY 7q - Zip ITELEPHONE eux P � .-q ZIP I TELEPHONE PERMIT EXPIRES USE PE11MIT /W:�Oq5 ZON NUMBER(D JOB SUITE/APT# AODRESS,,� PLAT NAME/SUBDIVISION NO. LOT NO. L�D NO. L D FEES PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Permit Required Street Use Permit Roq'd EXISTING — PROPOSED Inspection Requited 13 Sidewalk Required 13 REQUIRED DEDICATION— FT Underground Witing required CI METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 11 ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE ""I"" — _ , . — STATE LICENSE NUMBER EXPIRATIOPJ DAT /,//— a,-g 4? 6: q , 1/10,1V CHECKED BY VARIANCE OR CU SHORELINE OR ADBI I INSPECTION REO'D OyEs ONO I BOND POSTED S SEPA REVIEW COMPLETE , EXEMPT EXP SIGN AREA ALLOWED , PROPOSED HEIGHT ALLOWED I PROPOSED PROPERTY TAX ACC%iNT PARCEL NO. NEW RESIDENTIAL PLUM13ING / MECH COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE �PIEMODEL MULTIFAMILY SIGN GRADING FENCE REPAIR CYDS E] ( — x —FT) DEMOLISH 0 TANK OTHER GARAGE I RETAINING WALL o F RE SPRINKLER CARPORT 0 ROCKERY FIREALARM LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) FRONT SIDE REAR I PROPOSED SETBACKS (FE) FRONT URSIDE REAR I PARKING REQ'D I PROVIDED LOT AREA I PLANNING REVIEWED BY DATIE REMARKS (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: A 11111, V-4-4.110 1 CHECKED BY I TYPE OF CON$TRUCTION V-A` OCCUPANT GROUP NUMBER Z OF , _ __ NUMBER OF I DWELLING UNITS CRITICAL AREAS fW 44 NUMBER SPECIAL INSPECTION JAREA REQUIRED YES OCCUPANT LOAD —STORIES DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER USC IGOIFINAL INSPECTION REG'D a 614 &UV(LvLiq rowt ft, WJIA� _h W Q 1,� "41 VALUATION $ C jq OAt atth alk Description FEE Description FEE I, Plan Check State Surcharge GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 2 Grading DOMAIN (CURaS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180DAYS 06 PERMIT LIMIr 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 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 056/1 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE !3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due . 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE AM ORDINANCE PROVISION.' zi LIM 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 applicallon Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building OffiCial of 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 space provided. WORKNIEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE SIGNATURE (OW`Nli� AGENT) DATE IA95) % VK_ �GNED 771-0220 RELEiSRED DATE ATTENTION Off 1333 L�j- j-Q5 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- 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 z 0 1 0 M =i 9 M M a 10 C � C M M 10 C 0 _n "n M M a Vi 0 0 rn C 0) M 0 z z 0 1 0 M L, , A40S a- clqs P/ CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWtSNAME/NAME OF BUSI 0 Ree 1 (.0 ("n ffi MAILING ADDRESS -a a o A (h rPhadf Zip ITELEPHONE q NAME ADDRESS CITY ZIP ITELEPHONE IPERMIT EXPIRES USE 3ERMIT ZINE,kg/5 I NUMBER JOB SUITE/APT# ADDRESS 'C9 C'e sees PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Porrnit Required Street Use Permit Roq'd EXISTING - PROPOSED Inspection Required Sidevralk Required 13 REQUIRED DEDICATION- FT Underground ad 13 'W'"no oqu u- 'eq u! METER SIZE LINE SIZE NO. OF FIXTURES ;TV REQUIRED YES13 NO E3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE NAME C2 # V��/s ENGINEERING REVIEWED BY DATE ADDRESS CC 0 FIRE REVIEWED BY DATE Lu IC M CITY ZIP TELEPHONf_ L q 0 )72 yl� VARIANCE OR CU SHORELINEbRADB# 10YES INSPECTION REO'D 13NO BOND POSTED $ STATE LICENSE NUMBER EXPIRATIQ�J'E CHECKED BY SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED 4 PROPERTY C r PARCEL NO. EXP , , I NEW RESIDENTIAL PLUMBING/mEcH COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE rSVIREMODEL MULTIFAMILY 0 SIGN LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (Fr.) FRONT SIDE REAR PROPOSED SETBACKS (FT) FRONT LIRSIDE REAR PARKING REO'D PROVI PLANNING REVIEWED BY DATE REPAIR GRADING CYDS 0 FENCE X FT) REMARKS DEMOLISH TANK E:] OTHER GARAGE RETAININGWALL F RE SPRINKLER CARPORT 13 ROCKERY FIRE ALARM ITYPE OF USE, BUSINE S OR ACTIVITY) EXPLAIN: OWW_PS j CHECKED BY ITYPE OF COtiSTRUCTION V_A/ OCCUPANT GROUP lei C ITICAL J�0(f I I'), NUMBER NUMBER OF R It OF DWELLING AREAS STORIES U NITS NUMBER SPECIAL INSPECTION JAREA REQUIRED 0 Y OCCUPANT LOAD DESCRIBE WORK TO BE DONE I ALt. ('rat REMARKS z PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REaD "j oyjS�jq U VALUATION VV1151 &EPA I NEW an I hfi L Description FEE Description FEE Plan Check State Surcharge 45a A H§ekT,#OURCE e f f-I GLAZING % I LOT SLOPE % - Building Permit City Surchqrge PLM CHECK VESTED DATE Plumbing & IL2 :E�� - Mechanical THIS P 1 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO k: BE DONE ON PRIVATE PROPERTY ONIX AM CONSTRUCTION ON THE PUBUC Grading 2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPLICATION: ISODAYS IL PERMIT UMM 1 YEAR - PROVIDED WORK IS STAKED WITHIN 180 DAYS Engr. Inspection SEE 13ACK 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 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt # FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due lr'29 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE zi NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # 2(&,� I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRE" 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 IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Otficiai or his/her Deputy: and Fees are paid, and receipt Is acknowiedged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE SJQNATURE�OWNERW AGEfM DATE 1AID 1425) -k k 7GNED 771-0220 DATE ATTENTION W 1333 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 - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIE GREEN - ACCOUNTING S L z 9 0 M :q 9 M C M -18 0 C M M 14 10 z 0 _n '5n� E M M 0 0 Fn C2 K MO z W z 9 0 M