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20030225.pdfI 7, DATE RECZ� 0 1P ERMIT EXPIRES L CITY OF EDMONDS ZUNt: PERMIT NUMBE2C2&j CONSTRUCTION PERMIT APPLICATION' JOB SUnVAPT# ADDRESS OWNER NAMENAME OF BUSINESS 011 PLAT NAME/SUBDIVISION No. LOT LID NO. MAILING Ab"S LID FEE S I baur Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pem-A Required S" Uso Permit ReqV C Tyl I -771 EXISTING - PROPOSED InspectionRequirod SidemM Required REQUIRED DEDICATION- FT UnderWcuM WrItigrequirod 13 _,&tITELEPHONE NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES E3 NO 13 ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE CITY ZIP ELEPHONE T NAME CBLN 6zdd2z� ENGINEERING REVIEWED BY DATE ADDRES§ tod�M2 FIRE REVIEWED BY DATE CITY ZIP TELEPHONE SrATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND REaD POSTED OYEs 13-n 111 SEPA REVIEW SIGN AREA HEIGHT PROPERTY COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROP08ED EXP NEW RESIDENTIAL r] PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR -%FRONT LIRSIDE REAR COMPLIANCEOR ADDITION COMMERCIAL CHANGE OF USE [:3 REMODEL MULTIFAMILY SIGN PARKING LOT AREA PLANNING REVIEWED BY DATE REO'D PROVIDED REPAIR GRADING CYDS X FT) REMARKS 0 ER 0 DEMOLISH 0 TANK 1:1 Alm GARAGE RETAINING WALL F RE SPRINKLER CARPORT ROCKERY FIRE ALARM 12W (TYPE OF USE, BUSffl�S OR ACTIVITY) EXPLAIN: CHECKED BY ITYPE OF CONSTRUCTION 111HON7 NUMBER. [NUMBER OF CRIT' OF . . WELLING j D AREA rE SPECIAL INSPECTIO]NA!FEA OCCUPANT LOAD STORIES UNITS NUMB_4. 'z REQUIRED [3YEs DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC JOB/FINAL INSPECTION REaD .4 VALUATION $ escription FEE Description . FEE PI;In Check State Surcharge rz r I.ijay SOURCE GLAZING LOT SLOPE % Building Permit City Surcharge PLAN C HECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES O"iY THE WORK NOTED. THIS PERMIT COVERS WORK TO E: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading 2 M DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE k: SEPAM7 PERMISSION. Engr. RevieW PERmITAPPLICATI,om iioDAys PEAMIT LIMM I YEAR - PROVIDED WORK 18 BTAMD WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION PAPPLICANT. ON BEHALF OF HIS 68 HER SPOUSEi HEIRS. ASSIGNS AND SUCCESORS Fire Review PlaqChk. 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 N ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscaoinsp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt III I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECP AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE m comply WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit Until signed by the TION; AND IN DDING THE WORK AUTHORIZED THEREBY. NO PERSON MLL BE EMPLOYED Building Official of his/her DOPUtY: &nd Fees are pald, and IN VIOLAT HE LABOR CODE OF THE STATE OF WASHINGT0,14 RELATING TO FOR INSPECTION /1-') recelpt is acknowledged it, $Pace Provided. we 8 CO SATION INSURANCE AND RCW 18.27. S Slp4iURE DOTE ole E (425) M-RELASESC A/ AIA') - VAR� 771-0220 4ZA L BY DA NTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPKUVAL UH A (;EHfiFi- ORIGINAL -FILE YELLOW- INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES .. . . .... .... I DATE RECEIVED Z P/ V vo r CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINA4 F BL!SINE CMc— )ToK C MAILING ADDRESS 10 MNA)�S ZIP TELEPHONE CITY NAME ADDRESS CITY ZIP ITELEPHONE [PERMIT EXPIRES USE ZONE A/ PERMIT 10-0ZIM; NUMBER JOB SUITEJAP`T# ADDRESS �� L PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Approved El RW Permit Required Street Use Permit Req'd EXISTING — PROPOSED Inspection Recluked REQUIRED DEDICATION— FT Sidewalk Rociulrfd Und"Yound Wiring requirm METER SIZE LINE SIZE I I NO, OF FIXTURES PRV REQUIRED YES 13 NO 13 NAME /&)TEWAT)0W-)L S,1(�-N), ___'N ADDREIS HWY q9 -5, J� 2- CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPIF)ATIONDATE C!HECKE BY NTC-,�,scull . + PD 031by71Q3- [3 NEW [3 RESIDENTIAL [3 PLUMBING / MECH ADDITION 9 COMMERCIAL 13 OMPLIANCE OR cCHANGE OF USE REMODEL [:] APARTMENT SIGN [j REPAIR [3 GRADING CYDS [3 FENCE ( _ X _ Fr) DEMOLISH TANK OTHER - GARAGE CARPORT o RETAINING WALL ROOKERY RENEWAL ME OF USE. BUSINESS OR ACTIVITY1 EXPLAIN: , NUMBER NUMBN OF CRITICAL OF DWELLING AREAS STORIES I I UNITS /2//,+ 1 NUMBER lyl,4 DESCRIBE WORK TO BE DONE, --,I - _: - __jj A- 7-1 le / HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHEC VESTED DATE THis PERMIT ALITHoRms ONLY Ilk WORK NOTED. THIS PERMIT COVERS WORK To BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC :23 DOMN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERIMITAPPILICATION: IGODAYS PERMIT ILIMrs. I YEAR - PROVIDED WORK IS STARTED WITHIN ISO 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 PERMrT. 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 CITY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' A, I HFREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION; THAT THE INFORMATION GIVEN IS D I HFRES`y AC' I N CORRE"- ANO 21A VE 'a ZPILYAM E OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER.'I AGREE T WPH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND I DOING TI�HWORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED tINVIOLATI N OF THE BOB CODE OF THE STATE OF WASHINGTON rELATING TO Wo Pr I N E COMPEN. ION INSURANCE AND RCW 18.27. OW KAGEN"T)) =N_ DATE SIGNED 106i r io c >_ ATTENTION 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 10101 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 6 FIRE REVIEWBD BY DATE us cc 0 VARIANCE OR Cd SHORELINE OR ADS# INSPECTION BOND AM-07--2,11,0 REO'D [3 YES &00' POSTED SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEM ALLOWED PROPOSED ALLOWED PROPOSED 7 fo A. , EXP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT , LIR SIDE REAR A14 INA PARKING LOT AREA PLANNING REVIEWED BY DATE REOD PROVIDED I At'd _y /k 11211 REMARKS CHECKED BY I TYPE 0 .WNSTRUCTION IC OCCUPANT �GROUP SPECIAL INSPECTOR JAREAV OCCUPANT Lo REQUIRED [3YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D VALUATION $ Description FEE Description FEE Plan Check Buildin g Plumbing Mechanical Grading Recording Fee Engr. Review City Surcharge Engr. Inspection State Surcharge Traffic Mitigation Plan Chk Deposit Fire Review Receipt # Fire Inspection Total Amount Due Landscapainsp.1 Receipt # APPUCATIONAPPROVAI This application Is not a pe.mit until signed by the CALL Sul Q OMCW or his/her Deputy: and Fees are paid, and FOR INSPECTION receipt Is ackripMedgad In space provided. , 0 S SIONA7 UFJ5r 1A 03 w,-,,,5 771-0220 1 6ED 13Y nfrF EXT 1333 771-0221 ORIGINAL -FILE - YELLOW -INSPECTOR FAX PINK -OWNER - GOLD -ASSESSOR z 0 M 0M C M Oc M 10 z 9C 0 0 _n M M Fn C M 0 z M