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20030281.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNERNAME EBB MOUSIN Vfs MAILING ADDRESS, CPI ZIP TELEPHONE NAME ADDRESS CITY ZIP ITELEPHONE AID74 CITY STATE LICENSE NUMBER 751 rga ff mo 0 NEW RESIDENTIAL 0 PLUMBING/MECH 0 ADDITION COMMERCIAL COMPLIANCE OR 0 0 CHANGE OF USE 0 REMODEL 0 MULTIFAMILY 0 SIGN REPAIR GRADING CYDS o FENCE ( X FT) DEMOLISH TANK OTHER ci GARAGE CARPORT o RETAININGWALL ROCKERY 0 FIRE SPRINKLER FIRS ALARM frMF OF USE, BUSINESS OR ACTIVIM EXPLAIN: PERMIT EXPIRES Liz I Ij I I USE PERMIT ZONE /Z— NUMBER 01) S 0 0 D P P E N B D LA U E R B T E LI S C NA R ADDRESS PLAT NAME]SUBDIVISION NO. LOT NO. LID NO. LID FEE S TESCP APPVC)"d PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required Street Use Permit Req'd E X I G XISTING - PROPOSED inspection Required IST sidewalk Required R C I Undergmund EQUIRED DEDICATION- FT Wiring required IU METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YESD NO 13 k R 8 REMARKS I OW WC OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE NU1i413ER NUMBER OF CRITICAL OF DWELLING AREAS STORIES I UNITS NUMBER DESCRIBE WORK To BE DONE I I V1 DATE FIRE REVIEWED BY DATE VARIANCE OR CU S ORELINE OR ADB# INSPECTION BOND REO'D POSTED 113YEs 13NO 1$ SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED , PROPOSED I ALLOWED . PROPOSED z U11 J= rJ6 LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR z PARKING LOT AREA I PLANNING REVIEWED BY DATE REO'D I PROVIDED I CHECKED BY ITYP CON il SPECIAL INSPECTION JAREA REQUIRED [] YES REMARKS PROGRESS INSPECTIO1 OCCUPANT LOAD PER UBC 11081FINAL INSPECTION REO'D a," A, C-V Y-y-t 12 - VALUA11ON U $ E)ewription FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLA14 CHECK NO: VESTED DATE Plumbing I Mechanical THIS PERMIT ALM*ORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review a PERMI'll'APPLICATION: 180 DAYS PERMIT UMM I YEM - PROVIDED WORK 18 STASITED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICAW, 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 E Landscapeinsp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN CE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt B I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL 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- CALL Thisappli onisnotalperfriltunfilsignodbythe 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 Build!pj�ci r his/her Deputy: and Fees are paid, and rt i apace provid ,pelpt acknowledged ir FO SPE N 17t 9- WORKMEN-5AMM1104SATION INSURANCE AND RCW 18.27. OFFI I S N URE h, ATE DATE S717D 5) 771-0220 ASED� BY f DATE ATTENTIONV M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN L A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF - ORIGINAL -FILE YELLOW- INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR t)4/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 d 0 M a CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAM E OF BUSINESS A VI\VN =Vf S MAILING ADDRESS lve� — o 10 C ZIP TELEPHONE tqm NAME PERMIT EXPIRES USE 1Z PERMIT ZONE NUMBER 4-91 JOB ADDRESS �AveTM PLAT NAME/SUBDMSION NO. LOT NO. UD NO. LID FEE S TESCP Appm"d PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pame Raquired Strom U" Pwmh Roo EXISTING — PROPOSED— Inspoction PAquirod SW&wra ReWirad REQUIRED DEDICATION— FT Undwgrourid Wking raqWr6d 13 METER SIZE LINE SIZE [-7o7—oFFIXTURES PRV REQUIRED I YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE CITY ZIP TELEPHONE 1�w (or 116t I I I k I N�E IC v ((- W—A—L rj 7 ENGINEERING REVIEWEDIBY DATE DRES& gqFIRE REVIEWED BY DATE CITY ZIP 61TEVP7 &IIIII j 5 3E am: A-t I STATE LICENSE NUMBER EXPIRATION DATE GHLUED VARIANCE OR CU SHORELINE OR ADBO INSPECTIO BOND RE V'D POSTED I 10YES 1$ wu_7.1��enoaL_io �Z No SEPA REVIEW SIGN AREA HEIGHT PM ACCZ COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , I r] NEW RESIDENTIAL PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR 0 ADDITION COMMERCIAL U COMPLIANCE OR 0 CHANGE OF USE []'REMODEL 13 MULTIFAMILY Ej SIGN PARKING REaD I PROVIDE LOT AREA PLANNING REVIEWED BY DATE OREPAIR' [3 GRADING CYDS FENCE X FT) REMARKS bDEMOLISH [3 TANK OTHER '0GARAGE RETAINING WALL FIRE SPRINKLER 13 CARPORT ROCKERY FIRE ALARM (TYPE 'OF USE, BUSINESS OR ACTIVITY) EXPLAIN: mnmrmn"F� CHECKED BY ITYPP16 pCO. RUCTfN OCCUP N&T 1CO 0 GROUP R NUMBER ONWU BER OF �,OIF MELLING CRM AREACA�: SPECIAL INSPECTION OCCUPANT LOAD -STORIES NUM02R REQUIRED [3 JAREA RSCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/171NAL INSPECTION HE I 9 removt !2�4r YA2 10ft IA I VALUAMON U $ Description FEE Plan Check H—EAT SOURCE GLAZING % LOT SLOPE % Building Permit PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORtZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DOME ON PMVATE PROPERTY ONLY. ANY CONSTRUCFION ON THE PUBILIC Grading 3 :3 DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION. 180 DAYS PERMIT LIMFP I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 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 5 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection ALL CLAIMS FOR WOES OF ER NATURE ARISING DIRECTLY OR INDIRECTLY , MIT FROM THE . ISSUAN& OF THIS PERMIT SHALL NOT BE IIXCE OF THI=r 156 Landscapainsp. DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION. Recording Fee I HERE13Y ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GWEN 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. C C TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED at a' IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FO SPE N SAT WORKMEN`�.� ION INSURANCE AND RCW 18.27. OFF SIGNATU �ER ?)A ER GENT) DATE S1 �112 771 1 220 -022 ATTENTIOW/ EXT 1333 DescriptIon FEE State Surcharge City Surcharge Plan Chk. Deposit Receipt # Total Amt. Due Receipt # A/b APPLICATION APPROVAL This applin-MIOn is not a permit until signed by the dyV,Offlc or Nsftw Deptily: and Fefffare paid. and rp 'polp acknovAedgodinspaeoprovid .../j -J..... I— fi A I AAATC I By D , IT IS Ut4LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNT(L I :-,A FlIjkl) INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF kl� ORIGINAL -FILE YELLON- INSPECTOR C * bP OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR ATE 4102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING