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20030280.pdfI DATE RECEIVED �. 11 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS -�S'VN V) -�_ t I (_ 1,'r 5 ig o MAILING ADDRESS 93 -k I S r CITY ZIP TELEPHONE C 1 9 OA61 NAME ADDRESS CITY ZIP ITELEPHONE M_04 NAME —f� " )4j 6 , n -..' S CBL# I 1611 Cc ADDRESS 4044' 1 '�) S5 I fL IV E CITY �jr ZIP TTE.LEPHONE a vi� 19 a CA% STATE LICENSE NUMBER EXPIRATION DATE _roa% k Y D + K F 3 I MY. PROPERTY TAJ( ACCOUNT PARCEL NO 1241 192 10i2kL622 ll�a NEW -%3r RESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL 0 MULTIFAMILY SIGN REPAIR GRADING CYDS FENCE X FT) DEMOLISH TANK OTHER GARAGE CARPORT RETAJNINGWALL [3 FIRE SPRINKLER 0 ROCKERY FIRE ALARM UWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMBER OF CRITICAL OF STORIES DWELLING UNITS AREAS NUMBER DESCRIBE WORK TO BE D014E L 2 It - C1 /k-k C_�' CA -300 4.A 16,1 tA 5-T. HEAT SOURCE GLAZING % LOT SLOPE % T PLAN CHECK NO: VESTED DATE A).�L THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPLICATION: ISO DAYS 15 :RMIT LIMM 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 2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE q0 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 WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENS = URANCE AND RCW 18.27. DATE SIGNED Wo 3 ZONE JOB ADDRESS PERMIT EXPIRES Z ��/ PERMIT NUMBER 21003 _09�1(2 SUITE/APT# PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APP(0V9d RW Permit Required Strom Use Permit Req'd EXISTING __ PROPOSED Inspection Requited Sidewalk Required REQUIRED DEDICATION- FT U= METER SIZE LINE SIZE I NO. OF FIXTURES PRY REQUIRED YES13 NO C3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE BY DATE FIRE REVIEWED BY 1-Int- lViril 1VI 1"b- DATE LU Cc MUST BE PRESENT FOR M �_ W — VARIANCE ORCPAN *%4jWfthAW FEWIR BOND REQ'D POSTED �EZES EINOr. I SEPA REVIEW HEIGHT COMPLETE - EXEMPT I ALLC ncrn OWED - PROPOSED [REMAI LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR LLC PARKING LOT AREA I PLANNING REVIEWED BY DATE REOD I PRO IDED r =M RKS CHECKED BY JTYPE OE-ICONSTRtJON Cep&Z_ OCCUPANT MPf z: GROUP SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [ LOAD REMARKS I PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D VALUATION 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 # Landscapelnsp. Total Amt. Due Recording Fee Receipt # aL CALL FOR INSPECTION (A-05) Wr_ 771-0220 EXT 1333 APPLICATION APPROVAL This application Is not a permit until signed by the Building Offletall or his/her Deputy: and Fees are paid, and receipt Is acknoviledgod in space provided. OFFICIALS SIGNATURE D4TE I / -1 &911 ASED BY /DATE r fT 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 FINAL PROJECT APPROVAL FORM :i --fi 55 -3-1: om c M 0 80 m m 0 -Ti *n 3! 4 m C M m a 0 0 M C 0) c CO) M 0 X z -4 z 9 0 m ocaprvl.doc.l:temp:bldg:forms6/98 bi #r - #. MI. M DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION F 0 ER NAMEINAME OF BUSINESS WN C ONST C" RU' WNER Ep"E OF I IL �0 s LffiMAILI�NG ADDRESS S I S -e r r CITY CITY ZIP TELEPHONE j DrJ 5 E NAME ADDRESS CITY ZIP ITELEPHONE 4103 101 PERMIT EXPIRES I6SE PERMIT ZONE NUMBER Jot) SURVAPT# ADDRESS r I PLAT NAMk/SUBDIVISION NO. LOT NO. LID NO. LID FEE S —ATESCP PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Approved RW Pam* Required street use Permit RW EXISTING — PROPOSED Ifts Required 13 SidewaScRequira,41 13 REQUIRED DEDICATION— FT uW 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 1 1 ES 13 NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE NAME CBL# _f� ) 4,) DATE , ENGINEERING REVIEWED BY I I ADDRESS ti 40 KJ C— FIRE REVIEWED BY DATE us CITY ZIP TELEPHONE FIRE MARSH AL V6 104) �69-0a% S'53 STATE LICENSE NUMBER EXPIRATION DATE Y VARIANCE OR CLI "RBEP " BOND Ili' CUP POSTED -rarksj) + 00 1 KF b!�IoGlo 3 RE a PROPERTY TAX ACCO PARCEL SEPA REV, FEW* COMPLETE EXEMPT SIGN AREA HEIGHT PROPOS ALLOWED PROPOSED ALLOWED ED , EXP [3 NEW Iff RESIDENTIAL 1:1 PLUMBING / MECH LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) FRONT SIDE REAR FRONT UR SIDE REAR COMPLIANCE OR 0 ADDITION 0 COMMERCIAL 1:1 CHANGE OF USE _1P I REMODFIL muLTIFAmwy 0 jSIG: N ED BY DATE PARKING LANNING REVIEW 116 VID LOT AREA RECYD. PRO ED 0 GRADING CYDS FENCE REPAIR X,_ Fri REMARKS OTHER 0 DEMOLISH TANK in 2 11, 11 War [3 GARAGE RETAINING WALL o FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM In (TYPE OF U E. BUSINESS OR. PLAIN:- _i1tCMWY) E CHECKED BY ITYPEM—CONS1 ON OCCUPANT I WWI, GROUP T NUMBER NUGER 07 CRITICAL OF DWELLING AREAS 6W Z: SPECIALINSPECTION OCCUPANT STORIES UNITS NUMBER JAREA REQUIRED 13 YES LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REUD -300 C'k'A I I' tA 5 1. VALUATION $ Description FEE 088C p1lon FEE Plan Check State Surcharge HMSOUIRCE GLAZING % LOT SLOPE % Building Permit LVn CitySurcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUT14ORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DOHE ON PRIVATE PROPERTY OHL% AM CONSTRUCTION ON THE PUBLIC Grading 2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMSSION. Engr. Review ATM I so DAYS PERMrrAPPur pEnM;T UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE IIIACK OF PINK PaWIT FOR MORE INFOMUTION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit -NO AND HOLD HARMLESS THE CITY OF IN INTEREST. AGREES TO INDEMNIFY, DEFE 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 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due UPR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Receipt # s_4 Recording Fee I HEREBY ACKNOWLEDGE THAT I HAVE READ rile APPLICATION; THAT THE INFORMATION APPLICATION APPROVA L 11IVEN 18 CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE'QMER. I A GREE TO COMPLY WITH CrIY AND STATE LAWS REGULATING CONSTRUC. CALL TWs 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 Building OMcW or hLqftw Deputy; and Fees are paid, and FOR INSPEC71ON receipt is ajanowledged In space PrOvid9d. WORKMERS COMPENSATION INSURANCE AND RCVV 18.27. OFFICIALS SiGbIATURP YE IJATLIRE (0" OR AGENT) 0 I 7GN E D a"A03 1425) 1. -.1. /_1 jel')f L;ATE�S 771-0220 RELEASED 8 Y 4TfENTION 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