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20030294.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEAIAME OF BUSINESS a r ce?/r MAILING AADRESS r CITY ZIP TELEPHONE NAME ADDRESS CITY ZIP [TELEPHONE NAME ICBLN ADDRESS low*% LPERMIT EXPIRES IK3 I -00� USE PERMIT ZONE NUMBER r4hh JOB ADDRES:L�� /� 22 - g 70L SUITE/APT ti� PLAT NAME/SUBDIVISION NO. I LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW PermA Required Street Use Permit Req'd EXISTING - PROPOSED Inspection Requited Sidewalk Required REQUIRED DEDICATION- FT UnderiMand Wiring required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED i YES 13 NO 13 z REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE R ENGINEERING REVIEWED BY DATE L AQ�rlz FIRE REVIEWED BY DATE cc CITY ZIP TELEPHONE M VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D POSTED OyEs 13NO $ SEPA REVIEW SIGN AREA HEIGHT PROPEVY,TAX ACCOUNT PARM140. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 1-16,A19 (003 (00/ i904(p , , E_XP 0 NEW ESIDENTIAL xv 1:1 PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR ADDITION COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE 0 REM0j)EL MULTIFAMILY 0 SIGN RECID I PROVIDED 0"REPAIR GRADING CYDS E [3 F NCE X FT) REMARKS DEMOLISH TANK OTHER GARAGE RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE. BUSINESS OR ACTIVITY) EXP k_�< � 11 d L"17 " CHECKED BY TYRF OF CQNSTRUCTION OCCUPANT 177 NUMBER OF Inn4 ot, NUMBER OF DWELLING CRITICAL AREAS A11A I SPECIAL INSPECTION GROUP JAREA OCCUPANT STORIES UNITS NUMBER REQUIRED 13YES LOAD I DESCRIBE WORK TO BE DONE _ ._ 2 REMARKS PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG'D r o VALUATION C077-,)9-a?_51 V -Pr27 $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE -j-GLAZING % LOT SLOPE % Building Permit e- City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORMEStONLY'THE WORK NOTED. THIS PERMIT COVERS WORK TO t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading 2 DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: ISO DAYS L PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION A T ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS T PLT Ng Fire Review Plan Chk. Deposit 11 ;AP N INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # IEDMONDS, ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY ---- FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due 9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 2 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 P R VAAL APPLICATION APP L 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 This application Is not a permit until signed by thO 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 Buildinqe(nctai FOR INSPECTIC /reFfilpt or hIsther Deputy: and Foes are paid, and Is acknowledged In space provided. WORKME9 C NSATI _MEI ON INSURANCE AND RCW 18.27. _01- it IGNATLI DATE ORA DATE SIGNED 1A 1425) Ax A '0' a$,oj0W2NE Y/7 771-0220 oZa:9Z1ZU"ff4_4L1 ;CAM RELEASEEfBY DAP Zneml 1W 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 - ----- ------ I I ly,DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEMAME OF BUSINESS PrCll (4(_1y4e_, MAILING AADRESS r o CITY zip TELEPHONE _54011e.-liele- 5- - -77 8' Y 5C), NAME ADDRESS CITY ZIP ITELEPHONE NAME ADDRESS Cat. N YOM,%, LPERMIT EXPIRES USE PERMIT ZONE. '5�7 C:�& -- NUMBER :OB SUITE/ PT ADDRESS '�Dfzz, 921.- :Z?7*Pz D PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW PenrM Required Street Us* Peffnh Rsq�d EXISTING — PROPOSED— Inspection Required Sidews* Required REQUIRED DEDICATION— FT UnderWound WWg required METER SIZE LINE SIW7. I OF FIXTURES PRV REQUIRED YESD NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY DATE I 'r f I%- �f 4.1� FIRE REVIEWED BY DATE CITY ZIP TELEPHONE I I dV6 IEL STATE LICENSE NUMBER EXPIRATION KED BY VARIANCE OR CUI SHORELINE OR ADB# I INSPECTION BOND REO'D POSTED 13YES 13NO � $ SEPA REVIEW SIGN AREA HEIGHT PROPEFkTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT WED PROPOSED ALLOWED PROPOSED /_/6aRto , EXP [3 NEW WESIDENTIAL 0 PLUMBING/MECH LOT COVERAGE ALLOWED MOPOSED SETBACKS (Fr.) WFR' %1D4EM-J%rAL LJR SIDE REAR ADDITION COMPLIANCE OR [3 COMMERCIAL El CHANGE OF USE — jy- PARKING I LOTAREA IPLANNINCIREVIEW—ED'MV DATE REMO.PEL muLnFAmiLy SIGN REOD I PROVIDED Me'REPAIR GRADING 0 FENCE CYDS' X FT) REMARKS DEMOLISH E] TANK OTHER 0 GARAGE RETAINI�G WALL FIRE SPRINKLER CARPORT __ROCKERY FIRE ALARM else (rYPE OF USE. BUSINESS OR Ar-IrIVITY) EXPLAI CHECKED BY OF COAISTRUCTION OCCUPANT A'7 GROUP NUMBER NUMBER OF CRITICAL DWELLING AREAS 'M3 SPECIAL INSPECTION OCCUPANT STORIES UNITS NUMBER LVIA JAREA REQUIRED [3 LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPEC'nON REQ'D 0 4- 0 VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % -P LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical TMG PERMIT AUTWMGMB6NLV',TRE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading VAYS, MARQUEES, ETC.) WILL REQUIRE :3 DOUNN (CURM,SIDEWAM,DRM t: SqPARATEPEWSSION. Engr. Review PERMIT APPLICATION: 1180DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SE9 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 Fire Inspection Receipt # CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY IALL FROM THE ISSUANCE OF THIS PERMrf ISSUANCE OF THIS PERMIT SHALL NOT HE DEEMED TO MODIFX WAIVE OR REDUft ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapoinsp. Total Amt. Due R umrr IN ANY WAY THE cays ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* eeeeeeQW Recording Fee Receipt # 1 HjREEIY` ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION GIVEN IS CORRECr, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTtJORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building011ciall or hielher Deputy: and Fees are paid, and /rapilpt Is ocM"edged In speoc provided. WORKMIEV �MNSATICN INSURANCE AND RCW 10.27. IF OFAt_ kl.'o �INA U DATE BIG OWNE ORAGE>W--) DATE SIGNED (425) Z/ AV /Z- &7 771-0220 DA'14 A'17TENTInW W-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 z 0 4 0 M