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20030212.pdfDATE RECEIVED 6>-;97-12912 M, I C; CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER-NAMEINAME OF BUSINESS MAILING ADDRESS I -z I 's -1c" CITY ZIP TELEPHONE tTX-�� Vj� +ZG -T-1 I - CC)-2 0 NAMEy ADDRESS �0-z I I W, CITY TELEPHONE Lip, ki,p) NAME CBLN ADDRESS 2-13 11 CITY ZIP TELEPHONE A 9 S211 42-5-335 44.4-S STATE LICENSE NUMBER EXPIRATION DATE AMa(jV:;,600 _7 OC 211,5� /v 4 R 5r, PROPERTY TAX ACCAUNT PARCEL NO. 2-7040M3i v2_00 NEW RESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN REPAIR GRADING CyDr FENCE X DEMOLISH TANK OTHER 0 GARAGE RETAINING WALL CARPORT ROCKERY NF— UWE OF USE, BUSINESS OR 6CTIVITY) EXPLAIN: I:'*'- e , ,a --th(o NUMBER OF NUMBER OF DWELLING CRITICAL AREAS I STORIES UNITS oe NUMBER DESCRIBE WORK TO BE DONE PERMIT EXPIRES USEV ZON -J PERMIT NUMBER JOB ADDRESS SUITE/APT# -8429 _61%Aj PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I Ebur Approved RW Permit Required Street Use Parmit Req'd EXISTING — PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION-- FT Underwound Wiring req Ired METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED YESM NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE ENGINEERING REVIEWED BY DATE 15 z z FIRE REVIEWED BY DATE Ull 01 rL VARIANCE OR CU SHORELINEORADBO i INSPECTION BOND REO'D POSTED 13YEs 13NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED I PROPOSED I ALLOWED , PROPOSED EXP LOT COVERAGE I REQUIRED SETBACKS (FT.) PROPOSED SETBACK$ (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSiDE REAR z PARKING LOT AREA I PLANNING REVIEWED BY DATE RECeD I PROVIDED I FT) N REMARKS CHECKED BY ITYPE IIPECIAL INSPECTION JAREA UCULIPANIf REQUIRED [3 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REaD 9 it N HEAT SOURCE I GLAZING % I LOT SLOPE % PLM CHECK NO: �A ^ . 4 , I I VESTED DATE C:�62 �Uzx I �_Tmls PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPUCATION: 180DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WrTNIN 1130 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOnS 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 REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS RR T; AN I AM THE OWNED(OR THE DULY AUTHORIZED AGENT OF THE OWNE�Ro I !fRI`E TDO TCHOAMTPLY,4H CITY VW STATE LAWS REGULATING CONSTRUC- TION; AND %46ING THE WORKAUYHORIZE94HEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATIWOF THE LABOFI/CAE OF PE STATE OF WASHINGTON RELATING TO wnni(UEUS,COMPENSATIONAUgURANCEAND RCW 18.27. (OWNER OR/AaNTlj /_ I DATE $ 0,/ y - Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscapelnsp. Recording Fee CALL FOR INSPECTION (425) 771-0220 FEE Description State Surcharge City Surcharge FEE Plan Chk. Deposit Receipt # Total Amt. Due Receipt # APPLICATION APPROVAL This application Is not a permit until signed by the Building official or his/her Deputy: and Fees are paid, and receipt Is acknowledged In sp�co p jovided. A-UENT1019 EXT 1 Tj IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I i:91zaa-, A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 4rolAIGINAL - FIIE 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 FINAL 1PROJECT APPROVAL FORM of" T DATE:__---� MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION �6 F"6-? FIRE DEPARTMENT DAT`i-�( FROM: ENGINEERING DIVISION DATE ------ PLANNING DWISION DATE --------- PROJECT ADB#----------.;DATE INSPECTED— /- �4 YL PERMIT DESCRIPTION OF WORK To BE INSPECTED A field inspection was conducted to determine final compliance with approved plans. Final approval denotes that there are BO objections from the above signed Department to. the release of pORMANCE BON_DS and the granting of FO M" GRANT F]NAL PROJECT APPROVAL GRANT PROJECT APPROVAL WrrH CONDMONS NOTED C) copy of CONDMONS given to owner/conhwtor by inspector I . FAHM FINAL INSPECTION - OUTSTANDING ISSUES 13 COPY Of CORRECTION NOTICE given to owner/contractor bY inspector I . 2. 3. RE . _INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Si 0=prV1.d0c.1:wW-b1dg:f0rMS10/01 77-77771 J, r 0 Z", W anew DATE RECEIVE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS PERMIT EXPIRES USEE/ ZON PERMIT 1,4 oe��'�L NUMBER JOB SUI-fi/APT# ADDRESS'. PLAT NAME/SUBDIVISION NO. 07LOT NO. LID NO. c a MAILING ADDRESS peq e 0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING — PROPOSED REQUIRED DEDICATION— FT TESCP Approved RW Pennit Required Suest Use PennIt Req'd inspection Requited Sidews0t RaWked Undwitround Wking requVed CITY ZIP tZt>,�� =TZELEPHIONE —n 0 14AME METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED YES 13 NO 13 ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE (P-1- I I "001VI'lea�1 vvk Nt::� Crl T zip,) ,/I TELEPHONE /11 zz_ NAME CBL 0 huewc-Ae'j ENGINEERING REVI DATE ADDRESS EwM!foA Aid 95 Z FIRE REVIEWED BY IFT DATE us CITY cc ZIP TELEPHONE M k540HC4\Ak—'>A -5 C_ ?— I (f— (Z > ? 9 S2qq 5 -3 515 4( A BOND 11 — VARIANCE OR CU SHORELINEORADB# I INSPECTION .,.STATE LICENSE NUMBER 1cXPIRATIOj DATE B REQ'D POSTED -7 oc 47,47T, 13YEs ONO S PROPEM TAX ACCCLUNT PARQEL Ng 104 NEW RESIDENTIAL PLUM13ING / MECH ADDITION COMMER L COMPLIANCE OR CHANGE OF USE 41 REMODEL MULTIFAMI SIGN REPAIR GRAD I CYDS FENCE X FT) �ANK DEM06SH OTHER 0 GARACP C1 RETAJNINGWALL CARPORT 0 ROCKERY (TY PE OF USE. BUSJNtS8 OR #CTIVITY) EXPLAIN: NUMBER) NUMBER OF CRITICAL OF DWELLING AR AS STORIES UNITS NUEM13ER DESr WORK TO BE DONE SEPA REVIEW SIGN AREA HEIGHT - C . UMPLETE , EXEMPT I ALLOWED I PROPOSED I ALLOWED I PROPOS�01 LOT COVERAGE REQUIRED SETBACK$ (Fr.) PROPOSED SETBACKS (Ft) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR M PARKING LOT AREA I PLANNING REVIEWED BY DATE IL REO'D I PROVIDED I REMARKS CHECKED BY SPECIAL INSPECTION JAREA OCCUPANTJ REQUIRED [:] YE LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D _5 I HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHEC:n VESTED DATE,,�%�- THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS:dAKTo BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THEP BUd e:' DOLNUM (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) VVILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180DAYS PERMIT LIMIr 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 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 C17Y ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION., I HEREBY ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION: THAT THE INFORMATION D �� AV NED(OR THE DULY AUTHORIZED AGENT OF Y UT 0 T UL TATE LAWS REGULATING CONSTRUC- REBY No PERSON WILL BE EMPLOYED IZ 8 TE 6 F WASHINGTON RELATING TO CW M IS MR AN M / IS . Z T' OW 0 TH V PLY H C S G E R. E To TI AN � TH WORK 'IOR E E 0 'N ON. D ING E IN VIOLATI OF THE LABO E OF E TA WORKMF OMPENSATION URANIC No R .27 (OWNER OFIACEN71 Z, I DATE ILM III VALUATION 0 7 Description FEE Description FEE Plan Check State Surcharg Building Permit City Surcharge Plumbing Engr. Inspectiog,. Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapoinsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION (425) ?' 771-0220 EXT 1333 APPLICATION APPROVAL This application Is not a permit until signed by the Building Otficiall or his/her Deputy: and Fees are paid. and receipt Is acknowledged In splkco pfovided. OF GNAT DA E 31A rvL pi I V�) _REL "'FlY D&E IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL-FItE 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 . M k