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20030245.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS - MAILING ADDRESS (0 soc rA my NAME ADDRESS CITY NAME /-%A 1-1 ADDRESS 0 � c�2bl )+h PL ZIP TELEPHONE ZIP ITELEPHONE 3" FERMIT EXPIRES P USE PERMIT ZONE NUMBER JOB ADDRESS I :Z0 jA-_ SUITE/APT# PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APPr0V&d MY Permit Required Street Use Permit Raqd EXISTING - PROPOSED inspection ROqukbd Sidewalk Required [3 13 REQUIRED DEDICATION- FT UnderWound WWAg required 13 METER SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO 13 z REMARKS z OWNER/C T A WAGE INTR State I I TELEPHONE '_Q�P/W-W A —07/v � -11 D. lc:�� STATE LICENSE NUMBER PROPERTY TAX ACCOUNT PARCEL NO. NEW RESIDENTIA qrj- LUMB ADDITION COMMERCIAL ] COMP 1:1 CHAN( REMODEL MULTIFAMILY 0 SIGN REPAIR GRADING CYDS FENCE DEMOLISH 1:3 TANK OTHEF ciGARAGE CARPORT RETAININGWALL ROCKERY 0 FIRE S F�RE I (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: _.) V-,* Q_ NUMBER OF STORIES I Wlel IQ-:>r NUMBER OF DWELL NG UNITS I CRITICAL AREAS I NUMBER DESCRIBE WORK TO BE DONE [C- 0 BY DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE OR ADS# I INSPECTION BOND REQ'D POSTED _113YEs ONO IS If I. SE4 FIV SIGN ARW-t-------U=1L_ 'OMPLEJE . �&PEI 6f(LL&EQpnfR(xqM.L.��L0WED ING / MECH ALL6174 LIANCE OR E OF USE PARKING LOT AREA PLANNING REVIEWED BY RECID I PROVIDED I X_ FT) REMARKS P NK RI LER HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO* VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPUCATION: 180DAYS PERMIT UMrP 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 NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMrr. 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION 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- TION. AND IN DOING THE WOR THORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE 0 OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMP5P INSU CE AND RCW 18.27. sfoif- SIGNATU DATE SIT OW -4. .6 L/R is (F-r.) REAR z CHECKED BY ITY= C OCCUPANT GROUP SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [] YES LOAD REMARKS I PROGRESS INSPECTIONS PER USC I 081FINAL INSPECTION REG'D 9 $ 1 Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due 66. Recording Fee Receipt CALL FOR INSPECTION IAO 1425) 771-0220 APPLICATION APPROVAL This application is not a permit until signed bY the Building Offlclal or hisftr Depoll: and Fees are paid. and receipt Is acknowledged in apace provided. OFFICIALS 7�SINATU DATP rR-ELEASED BY ATTENTION M I IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I 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 I 1001 oil ('00) low v 3 O�ft A3 ji-Al CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME-OF BUSINESS yew - MAILING ADDRESS J PL ZIP ITELEPHONE NAME ADDRESS CITY ZIP —[TELEFH6NE DATE WRECFiViED F USE PERMIT Wo- ZONE NUMBER JOB ADDRESS COJ50Z /-;t PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW perrr�j Required Street Use Parmn RAq`d EXISTING — PROPOSED trispection Required SidewarARequirod REQUIRED DEDICATION— FT underground Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I [3 z Yu REMARKS T�—_ I 0 WNERICO 91 NAME CBL # C ENGINEERING REVIEWED BY DATE ADDRESS FIRE REVIEWED BY DATE C ZIP TELEPHONE cT 9 rL wilb 1 VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CH REQ'O POSTED I G C A WYICC�.o 13YEs -13NO &=4 .1 _... , , PROPERTY TAX ACCOUNT PARCEL NO. Re"TrEw 7"N.AREA HE HT C I Al%ff'�M kl) YfMSJ Wee ALLOWED PROPOS ftE hing in EX nutlUtnCM NEW RESIDENTIAL LUMBING / MECH �3_ L8 RVE — _G_ W) 9POPOSED S CKS (Fr.) EON M Ro T AL 6.,C IDE REAR ESI 8= xx_ COMPLIANCE OR [3ADDITION COMMERCIAL El CHANGE OF USE REMODEL MULTIFAMILY [3 SIGN PARKING REQ` PROVIDED LOT AREA PLANNING REVIEWED BY DATE [3 GRADING FENCE REPAIR CYDS 0 ( X FT) REMARKS n DEMOLISH TANK Ej OTHER [3 GARAGE RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACTIVrM EXPLAIN: V_.o CHECKED BY ITYPEIMT7�CP17 OCCUPANT GRO NUMBER k,4NUMBER OF CRITICAL OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT STORIES UNITS NUMBER REQUIRED[] YES LOAD 'DESCRIBE WORK TO RE DONE REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG-0 C) I C, 2 VALUAnON UU111F 664 1=W $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE T_ GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO, VESTED DATE Plumbing Mechanical 20 THIS PER341T AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO h 13E DONE ON PRIVATE PROPERTY ONILX ANY CONSTRUCTION ON THE PUBUC Grading 2 ETC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, WILL REQUIRE 3 t: SEPARATE PERMISSION. Engr. Review PER111ITTAPPUCATION: ISO DAYS pERuff umM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 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 DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt 0 ALL CLAIMS FOR FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE iDEEMED NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." t Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THis AP�LICATION; THAT THE INFORMATION APPLI CATION APP)OVAL GIVEN is CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This aWication is not a untff signed by the THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC- TION: AND IN DOING THE WORK ALITHO IZE THEREBY, NO PERSON WILL BE EMPLOYED CALL permit Building OMcW or hi0or Deputy: and Fees are paid, and IN VIOLATION OF THE 1.4001EGow THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknovdedgod in space provided. WORKMENS COMP5VSA1110f INSU CE AND RCW 18.27. A —1 FNATUqE APWNJ�C( DATE SN 3NfD 17,) SIG 'Im, _�' " < A V__ IA95) OFFICIALS S?NATU�E DATP .4 1-02 0 RELEASED BY ATTENTION EXT 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 COPIES GREEN - ACCOUNTING 5