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20030299.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS Keylyl kad MAILING ADDRESS I 1� a 1b) CITY ZIP TELEPHONE U','as NAME ADDRESS CITY NAME TctnM ADDRESS CITY LrP STATE LICENSE NUMBER ZIP I TELEPHONE ZIP TELEPHONE 9 g 15 1 51 TAX ACCOUNT PARCEL NO. CBL 0 71 13 NEW RESIDENTIAL x 0 PLUMBING/MECH 0 ADDITION 0 COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE 1:1 REMODEL 0 MULTIFAMILY 0 SIGN 0 REPAIR 0 GRADING CYDS [3 FENCE X FT) 0 DEMOLISH TANK 0 OTHER EGARAGE l CARPORT RETAININGWALL 0 ROCKFRY FIRE SPRINKLER 1:3 FIRE ALARM &YPE OF USE. BUSINESS OR .ACTh0M,*?LAJN: NUMBER NUMBER OF RITICAL OF DWELLING AREAS NUMBER 0 UNITS STORIES ST DESCRIBE WORK TO BE DONE ------- .... 7 PERMIT EXPIRES USE PERMIT Z NE Qa ONE NUMBER 2-VrL�� - ( ) JOB UITE/M# A D DDRESS F lss- PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE 9 ic Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Pemilt Requked Str &I Use Permft Wd EXISTING — PROPOSED Ins=n Roquired Sidewalk Ractuired REQUIRED DEDICATION— FT UnderGround Widrigrequired METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED I � YES [3 NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE DATE FIRE REVIEWED BY DATE W cc 0 — VARIANCE OR CU S HORELINE OR ADB# INSPECTION BOND ]. I REO'D POSTED IS DYES 13NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED EXP , I LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR PARKING I LOT AREA I PLANNING REVIEWED By DATE 06 REO`D I PROV TANK FILL, REMOVAL, OR CAP CHECKED BY ITY!= OCCUPANT ]AREA GROUP K5- SPECIAL INSPECTION OCCUPANT LOAD REQUIRED [] YES REMARKS PROGRESS INSPECTIONS PER UBC 108MINAL INSPECTION REO'D Description FEE Description FEE A!/// Plan Check State Surcharge e HEAVsouRCE --�MNG % LOT SLOPE % Building Permit City Surcharge -P 15- PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMrr AUTHORLMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. t: — Engr. Review 5 PERMIT APPLICATION: ISO DAYS IL PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 150 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 Plan Chk. Deposit IN INTEREgi. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt P 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 Landscapelnsp. Total Amt. Du NOR LIMIT IN ANY WAY THE CrrrS ABILITY TO ENFORCE ANY ORDINANCE PROVI I SION.- Recording Fee Receipt # 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 Y WITH CITY AND STATE LAWS REGULATING CONSTRUC- THE OWNER. I AGREE TO COMPL CALL This application Is not a permit until signed by the Building Otficial or his/her Deputy: and Fees are paid, and 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 FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSA3900INSURANCE AND RCW 18.27. OFFICIALS SIGN)ITURE DATE SIC;irNARE (OWNER 0!AG.W DAT9,SIGNED (425) L 771 -0220 DATEft 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- 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 z 0 0 M M C M 0 C � r. M M 10 � z 0 -n M M 0 ra 0 0 Fn C9r. 0 0 M FINAL PROJECI APPROYAL FORM TO- z 9 0 m =i =6 m ma 0 80 c IC MM m Z -4 lcol 0 _n n � � ic mm a ai 0 o rr; c 0) c cn M 0 z q z co z 9 0 m -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPRO)�AL ocaprvl.doc.l:tcmp:bldg:forms6/98 1 I P I . *r pl Z, r 14P 1 1 6 I. 4 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS S ZIP TELEPHONE CITY ZM!i ADDRESS CITY ZIP NAME Tain t) ADDRESS lqc�cil CBL # —0 PERMIT EXPIRES USE PERMIT ZONE NUMBER r2z-�—n 2_4 JOB ADDRESS M?31 — S13 lr� SUITE/APT# tt) PLAT NAME/SUBDIVISION NO. LID NO LID FEE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Ponrilt Required Sum u&Q Pennh R00 EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground WWorequired METER SIZE LINE SIZE I I NO. OF FIXTURES PRV REQUIRED YES[3 NO 13 ciw I ZIP TELEPHONE Lrf? 99 15 5 1 — I STATE LICENSE NUMBER NEW RESIDENTIAL PLUMBING / MECH ADDITION commERcLAL COMPLIANCE OR CHANGE OF USE REMODEL MUL11FAMILY SIGN REPAIR GRADING CYDS FENCE 13 ( 0 DEMOLISH TANK —x—Fr) OTHER oGARAGE CARPORT RETAJNINGWALL 0 ROCKERY FIRE SPRINKLER FIREALARM _0 (TYPE OF USE. BUSINESS nCTr lorN: NUMBER J—NUMBER OF CRITICAL OF e2m STORIES 4 DWELLING UNITS 1 1 AREAS 1 NUMBER DESCRIBE WORK TO BE DONE -do PLAN CHECK NO: REMARKS OWNER/CONTRACTOB RESPONSIBLE FOR EROSION CONTROUDRAINAGE BY FIRE REVIEWED BY DATE DATE VARIANCE OR CU_ SHORELINEOR ADBN I INSPECTION BOND REO'D POSTED OyEs 13NO IS SEPA REVIEW SIGN AREA HEIGHT PROPOSED ALLOWED PROPOSED COMPLETE . EXEMPT ALLOWED , I I LOT COVERAGE REQUIRED SETEMCKS (Fn� PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE I REAR PARKING LOT AREA I PLANNING REVIEWED BY DATE REO'D I PROVIDED ..ARS-HA6 CHECKED BY R)"OVA CWNT� _iPECIAL INSPECTION JAREA OCCUPANT REQUIRED rl YES I LOAD REMARKS I PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D $ Description FEE Description Plan Chock State Surcharge Building Permit JYOI City Surcharge Plumbing Mechanical THIS PERUff AUTHOREMS ONLY THE WORK NOTED. THIS PERMIrf COVERS WORK TO I: BE DOME ON PRIVATO PROPERTY ONILX ANY CONSTRUCTION ON THE PUBLIC Grading 2 1 3 DOLMN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) W LL REQUIRE 1: SEPARATE PERMSSIO". Engr. Review PERurr APPLjcATI0*. 190 DAYS PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WffHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION LOT SLOPE % VESTED DATE FEE -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 'HIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORIMMATION 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, This applicatlop is not a permit until signed by the Buktirg OMcW of his/her Deputy: and Foos are paid, and 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 FOR INSPECTION receipt Is acknovAefted In space prWded. WorAMEWS COMPENECE AND RCW 18,27. SIGN* T OFFIC URE E 1111_ SIGNATURE (OMER DATq PIGNED (42 U14 Mk2L J 2 771 -022W RELEASED BY I DKrE I ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR A FINAL CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUWING z 0 4 0 M :;:R V5 � 0 M C M M M z 0 _TI njM 0. [7n,- 0 z z: 0 0 M