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20030297.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS 'F—DITH N-fF_MjFXW MAILING ADDRESS G 9 1 CITY ZIP E 2� ITELEPHON _ q go. 0 1 :2 - $36 NAME _ 42c' ADDRESS CITY ZIP I TELEPHONE NAME CBL# LOCI O_U NIVFRUCROW 11:31 Wo ADDRESS 11-7 L-INCOL44 CITY zip TELEPHONE STATE LICENSE NUMBER EXPIRA ION DATE CHgP6Eq BY :41 PROPERTY TAX ACCOUNT PARCEL NO. -71 NEW z RESIDENTIAL 11 PLUMBING MECH o COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE REMODEL MULTIFAMILY 0 SIGN E] FENCE REPAIR GRADING CYDS X FT) 0 TANK DEMOLISH M i GARAGE I RETAINING WALL FIRE SPRINKLER CARPORT 13 ROCKERY FIRE ALARM IE: M?E OF USE, BUSINESS OR ACTIVnYI.EXPLAIN: 0 NUMBER NUMBER OF CRITICAL N��C, OF DWELLING STORI UNITS NUMBEO-A-0 AREAS ESC!g WORK TO BE DONE =PL A/ Vj LQ&A'r, EAT SOURCE GLAZING % LOT SLOPE % PLAN CHECKNO- VESjrEq DATE 1,99 ::AA7 41z 3 L& ss THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERirr COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 00 MAIN (CURSS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: ISO DAYS LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE 13ACK 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 THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 0 NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRE" 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'��SATION INSURANCE AND RCW 18.27. I SIWTU_REVd#NEP ,bR.AGfN1)- DATE SIGNED P ER MIT EXPIRES USE I ZONE PERMIT Oe'54,12- NUMBE&&,6-e'��gi?'7 JOB SUITE/APT# ADDRESSO PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ 7ESCP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required Street Use Permit Req'd EXISTING — PROPOSED InspecOorlRequired Sidewalk Required REQUIRED DEDICATION— FT Underwound wiring required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES 13 NO C3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE HANCE 0 SHORELINE OR ADBN ESPECTION BOND O�13YEs ONO $ POSTED SEPA REVIEW SIGN AREA I HEIG14T COMPLETE, EXEMPT I ALLOWED. PROPOSED IWI=n . PROPOSED LOT COVERAGE REQUIRED SETBkCKS (FT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE BEAR FRONT 118610F FEAR ............. PARKING LOTAREA 1PONNING REVIEWED BY DATE REO'D PROVIDED I-- - - 1 AN-k CHECKED BY ITYPE OLP-MTJIUCTION CODE OCCUPANT GROUP P SPECIAL INSPECTION AREA OCCUPANT REQUIRED [] LOAD YES AA._.� I REMARKS PROGRESS INSPECTIONS PER UBC 1101111MINAL INSPECTION REaD 'A�0- Description Plan Check Building Permit Plumbing Iviechanical Grading Engr. Review Engr. Inspection FEE"Description FEE State Surcharge City Surcharge a Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due_ 64 Recording Fee Receipt # �7 Z APPLICATION APPROVAL CALL This application Is not a permit until signed by the FOR INSPECTION Building official or his/her Deputy: and Fees are paid, and receipt Is acknowledged In space provided. OF NATU ATE %'425) 41�2_Ar 771-0220 L ED BY '/ DATIt ""' AITENTION - I f / M 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-INA R CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING 0 W 111111[i z 0 q 0 M M M 0 ic M M z z 0 _n M M z 0 M I Zr -M PV A,j DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS 151), ITH N [��M I XDW MAILING ADDRESS 6 9 12. - 19-7 it ?I - 17N 1 'CITY ZIP JTELEPHONE rl-WoOrh q zo* 142-9-143- 1-3b ADDRESS CITY ZIP .,AOL VU3 PERMIT EXPIRES USE PERMIT ZONE NUMBE0&,6-61947f-- JOB SUITE/APT# ADDRESS& /151 P" Alt 54U PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved Require RW PerrrA Ir d EXISTING — PROPOSED street Use Permit Rq'd inspection Required sidewalk Required REQUIRED DEDICATION— FT — UnderWound vAringraquived METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED 131 1 [ YES E3 NO IC3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE NAME CBL # et N /;I —Flu CTI 0 W ENGINEERING REVIEWED BY DATE cc ADDRESS, 0 11-7 L-INCOLN FIRE REVIEWED BY DATE LU I CITY zip TELEPHONE IfIc �NV1404117fl 952-90 130 % VARIANCE OR CU SHORELINEOR ADD# INSPE71ON BOND STATE LICENSE NUMBER EXPIRAZO14 DATE I CHW.K* BY .R6Q.2 POSTED JOYEs ONO $ SEPA REVIEW SIGN AREA HEIGHT 0:31 PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT I ALLOWED I PROPOSED I ALLOWED I PROPOSED -.0 A— L-1VVU-1fjV NEW RESIDENTIAL PLUMBING / MECH rj ADDITION COMMERCIAL 13 COMPLIANCE OR 13 CHANGE OF USE 0 REMODEL MULTIFAMILY SIGN 0 REPAIR GRADING CYDS [3 FENCE X_FT) DEMOLISH TANK 09 GARAGE RETAINING WALL ROCKERY 0 FIRE SPRINKLER FIRE ARM CARPORT OWE OF USE, BUSINESS OR CTYJJ�WPLAIN: NUMBER NUMBER OF CRITICAL OF STORIES DWELLING UNITS AREAS NUMBE02A— 0 DESCRIAIYORKTO BE DONE HEAT SOURCE GLAZING % LOT SLOPE % ni AU d%UMf- VESTED DATE LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT . SI Egan - REA I PI.ANNING REVIEWED BY DATE41 PARKING LOT A REO'D PROVIDED CHECKED BY ITYPE SPECIAL INSPECTION REQUIRED [] YES _[REMARKS M P P OGI ROGRESS INSP VALUATION $A 1402 Description Plan Check Building Permit Plumbing OCCUPANT GROUP OCCUPANT LOAD PER UBC 108/FINAL INSPECTION REO'D FOEE Description FEE State Surcharge City Surcharge_ .2 Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NaTED. THIS PERMIT COVERS WORK TO IDE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CUM, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL R . EQUIRE SEPARATE PERMISSION. Grading Engr. Review PERMIT APPLICATION: 180 DAYS PERMIT UMrr 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 I 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 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 'NOR LIMIT IN ANY WAY THE CnY8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Engr. Inspection Fire Review Fire Inspection Landscapelnsp. Recording Fee Plan Chk. Deposit I To — Receipt III Total A it. Due Receipt I I 14EREDY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION �Aml n AnrMT nc APPLICATION APPROVAL .GIVEN IS CORRECT. AND THAT I AM THE OWNER. Un InE VULT — This application Is not a permit unfit signed by the THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL V: and Fees are paid. and TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Officiall or his/her DePO IN VIOLATION QE THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN!A!!SNBATION INSURANCE AND RCW 18.27. OF I NATURV AT E DATE S71 NED/ (425) xd�� I . . gil- -KLr;J ED BY EXT 1333 771-0220 NTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL YELLOW - INWECTOR A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR GREEN - ACCOUNTING 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES z 0 d 0 M M M 0 C 52 M M 10 C 2 0 "n .n M M 0 z z 0 0. M