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20030262.pdfI 1 DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER.NAMEIWE OF BUSINESS . In ZIP NAME ADDRESS CITY ZIP WIRES USE PERMIT ZONE NUMBER J013 1 ADDRESS Z'3 J3 L30 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCIP Approved RW PerrM Required Street Use Permit Roq'd EXISTING - PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION- FT UndwWWW WIMg required [3 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I I YES 13 z REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE NAME CBL N ADDIR SOS 9,M) [UN 14 CITY ZIP 1"TELEPHONE STATE LICENSE NUMBER EXPIRArION DA4TE4H�ECKED BY PROPENrY TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL D1 PLUMBIN:!�/�MECH ADDITION COMMERCIAL 'bOMPLIAN CHANGE OF USE REMODEL MULTIFAMILY SIGN REPAIR GRADING CYDS FENCE ( DEMOLISH E] TANK OTHER GARAGE [:3 RETAINING WALL 7RE SPRINKLER CARPORT ROCKERY FIRE ALARM I[TYPE OF USE, BUSI ACTIVITY), EXPLAIN: CRITICAL AUEAS R N MBER NUMBER OF STORIES NUMBER OF DWELLING UNITS 0q DESCRIBE WORK TO BE DONE FT) required on npRiian ENGINEER! NlWftep*� Sp'aCe& 1frVIC 815.f JE FIRE REVIEWED BY DATE W IEL VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REO'D POSTED ONO $ $EPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT I ALLOWED . PROPOSED I :ALLOWED . PROPOSED LOT COVERAGE REQUIRED SETBACKS (Fr.), PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR PARKING NINO R RE(YD I PROVIDED I LOT AREA 1>�AN EVIEWID BY DATE % Q CHECKED BY 1:)!=N SPECIAL INSPECTION JAREA REQUIRED [3 YES REMARKS PROGRESS INSPECTIONS PER UBC 11080 GAS PIPE 7 OBSERED BY VALUAFION $ F Description FEE Plan Check OCCUPANT GROUP OCCUPANT LOAD I INSPECTION REO'D U110T nr Description State Surcharge FEE HEAT SOURCE GLAZING % LOT SLOPE % 'Building Permit S119 City Surcharge �5;00* PLAN CHECK NO: VESTED DATE Plumbing Ph ko Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC Grading 3 0 MAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION: 1180DAYS PERMIT LIMIT! I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT Fon 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 91 DEEMED TO OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due MODIFY, WAIVE OR REDUCE ANY REQUIREMENT 2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee =Receipt # I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION 7 APPR61WL GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CrTY 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 Official or his/her Deputy: and Foos are paid, and IN VIOLATION OF THE LABOR CODE OF 1 HE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknovAodged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE SIGNATURE OKGEW011 DATE SIGNED IA9 e�M /_/A 7(OWNER —z p3 771-0220 0A R SE Y D TE 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' INSACTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING l*j, FINAL PROJECT APPROVAL FORM TO: z 9 0 m :; =n- m M 0 0 m m z cn 0 -n n m m 0 U5 0 o Fn C 6) K co) M 0 Z .q� X z z 9 0 m 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Sign, ocaprvl.doc.l:temp:bldg:for=10/01 4 v 1.4 ly I 1 4 '.4 IT 1 44 ff t .3 t �Wlf"V ell IT -of ........... �., . ., 1 1. 1 . I I I �. 4' , %, 00, PNI ji M V.-A ,PIT ��v it If I no I ANIL f JDATE RECEIVED� CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEA"E OF DUSINE89 1101f�&If_ / InAthsl x#—L It, E (2 NAME ADDRESS CITY ADDR $08 O)aP7 () CITY 6 22�_ STATE LICENSE NUMBER ZIP ' ITELEPHONE ZIP [TELEPHONE zip I I TELEPHONE CBL III r . - _'0"0- 2 LPE R = T EXPIRES USE PERMIT ZONE NUG6 �7ft 013 ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Permit Requited Street Use Pornth Req'd EXISTING — PROPOSED Inspection Required S Required REQUIRED DEDICATION— Fr ewalk U = W1411091-4-1— 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 1 1 I YES13 NO E3 z I REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAG E DATE I CHECKED BY PROPE TAX ACCOUNT PARCEL NO. 0 NEW RESIDENTIAL PLUMBIN MECH ADDITION co MMERCIAL COMPLIAIN��R CHANGE OF USE 13 REMODEL 13 MULTIFAL41LY SIGN 13 REPAIR GRADING CYOS FENCE I I X Fri .0 DEM I OLISH TANK 0 OTHER 1 �.GARAGE :1 CARPORT RETAINING WALL 0- ROCKERY 0 FIRE SPRINKLER FIRE ALARM (ME OF USE, BUSI EBB OR ACTMM EXPLAIN: NUMBER OF STORIES NUMBER OF DWELLING UNITS CRITICAL AREAS NUMBER DESCRIBE WORK TO BE DONE 0 HEAT SOURCE GLA23NO % LOT SLOPE % PLAN CHECK NO' VESTED DATE THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPLICATION: 180 DAYS PERMIT UMrP'l YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION N 'APPLICANT, ON BEHALF 91"HIS OR HER SP . OUSE, H . EIRS, ASSIGNS AND SUCCESr'6 AN 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 RMIT FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PE SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY&M ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDIPrCE PROVIS101j.' I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATI GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYA1 IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON BEL-ATIN WORKMERS COMPENSATION INSURANCE AND RCW 18.27. \9 TI DATE ;IGNED SIGNATURE (OWNER OKGENT) 11 ' a II-A!'0011 Ci`�' I "-n - ENGINEERING REVIMEDBY- V �q DATE FIRE REVIEWED BY DATE [a W. M VARIANCE OR CU SHORELINEORADB# I INSPECTION BOND 1A*0z_(=_41Ws REO'D 13NO1$ OSTED SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOW ED PROPOSED 7—L-, ALLOWED PROPOSED EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR ---------- PARKING LOT AREA I PLANNING REVIEWED BY DATE !ELIn VIDEO r.-� X_ 0 - _�_ 441 CHECKED BY ITYPE OF CONSTRUCTION CODE OCCUPANT GROUP I . — SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION RECV0 Description Plan Check Building Permit Plumbing Mechanical [ 'gngr. Review m Engr7s FEE Description State Surcharge 0 1 'City Surcharge , 6) FEE ev Flry"FtQview 'R Plan Chk. Deposit Ir I on Receipt # scapoinsp. Sca Total Amt. Due r heloo .'o Fee I Receipt # APPLICATION APM I Cj CALL AR This application Is not a permit untli signed by the Building 0111cial or his/her Deputy: and Fees are paid, and INSPECTION recelpt Is acknovAecigod In space provided. OFF "CIGNATURE DATE (A9 14 %425) - 77 -0220 1 R BE Y A17TENTION Off 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 - INS#!(ECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04102 PRESS HARD -YOU ARE MAK nl(� 5,PPPIES GREEN - ACCOLIWING