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20030416.pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS P'l-TA �-[ o2prep MAILING ADDRESS sw �� — I 'C—W CITY ZIP TELEPHONE EDMOtQIDS 3902f-- 4-2_1S-G::�2-3132_ NAME ADDRESS CITY ZIP ITELEPHONE NAME CBLN 66-e- Johrsr,, RumL loi( ADDRESS C-01 looll czi�wooig /\ue CITY Zip TELEPHONE cgr#U, _99,1_3z ao(O-4-99-9-:�a STATE LICENSE NUM13ER EIPIrTION DATMEMBY 69- re, J-P_r S.-D NEW RESIDENTIAL NG MECH I ' ADDITION El COMMERCIAL TLUM.B e NCE OR CM GE OF USE REMODEL 1:3 MULTIFAMILY 0 SIGN REPAIR [3 GRADING CYDS [3 FENCE X FT) DEMOLISH 1:1 TANK 1:1 OTHER 3 GARAGE RETAINING WALL 0 ROCKERY [3 FIRE SPRINKLER FIRE ALARM _CARPORT CrYPE OF USE, BUSINESS 9BA9"1ff)fj6(PLAJN: NUMBER DNuMBEjFN1OF ICAL ELL G CRIT OF AREAS STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE 7y HEAT SOURCE GLAZING % I LOT SLOPE % PLAN CHECK NO: I VESTED DATE THIS PERMIT AUTHORMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARIQUEES. ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. It: PERMIT APPLICATION: ISO DAYS PERMIT ILIMM 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 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 BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 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 PERMIT EXPIRES USE PERMIT ZONE NUMBER J013 Sulw'�FT# ADDRESS z ( :3 ( S%" S I PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE $ TESCP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pormil Required Sir of Use Permit ReWd EXISTING - PROPOSED lns=n Required sidewalk Required UndefWound REQUIRED DEDICATION- FT Wiring required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YEsE3 NO C3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE SHALL BE INSTALLED NEA_R ' ENGINEERING REVIE%411MWA11R SH= DATE FIRE REVIEWED BY DATE VARIANCE OR CUI SHORELINE OR ADB# I INSPECTION 1$ BOND REO'D POSTED [3YEs ONO SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LfR SIDE REAR PARKING 11 LOT ARE:A�XPLANNING REVIEWED BY DATE REO'D I PROVIDED TO UPC 605.2 BUILDING CHECKED BY ITYP TRU ION I-Ift1h OCCUPANT _011 -GROUP C3 SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION RE(I'D VALUATION Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscapeinsp. Recording Fee FEE Description FEE State Surcharge JC) I City Surcharge � '147— Plan Chk. Deposit Receipt # Total Amt. Due Secelot # PPROVAL Tkf!!�-12A-91! a ! r I until sioned bv the 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 CALL ar!�Klal or hisk,er Deputy: and Fees are paid. and IN VI DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION t is ackgbvvIodged In space provided. WOR MEN'S C N ION INSURANCE AND RCW 18.27. 0 IAL 11 N (a ATE DATE SIGNED /A'25) %-r&l t 12A (o � 12, /D3 771-0220 nRELEA E$DRY DATE ATTENTION EXT4439T IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Zfo L A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl- 12. ORIGINAL -FILE YELLOW -INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING 95" 3 15 Z I NN z 0 M M M 0 C �2 ic M 10 0 -n M M 0 rn C CO) CO) 0 X z 0 M FINAL MimelOJECT FORM TO: DATE: PERmrr COORDINATOR, BURDING DWISION -ME DEPARTMENT DATE-�., ENGINEERING DIVISION DATE-�j �S'Z(20-3'. 2. 3. RE-INSPECrED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Doe Si W4pvLdoc.bmw-.bWr-fimwl0/01 z 0 -49 US -r' 10 M c M 0 80 a --I C :r M M z C) -4 c cl) 0 -n n m M a 0 091 c c V) M 0 Z .4� M z CA z 9 0 m s ATE RECEIVEt L"LDA USE Z CITY OF EDMONDS I ONE f J O[IERMITEXPIRES 17-11 ZJ PERMIT �2 NUMBER —OU 0 JUD %&%JIM KuLv I 1UN rcnml I APPLIL;A 1UN ADDRESS 17 ,:1 jSUrrPAPT# I OWNER NAMEAME OF BUSINESS P-rA �--1 12R.P ED MAILING ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. A — zW PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP CITY ZIP TELEPHONE EXISTING — PROPOSED— &Dmut�Ds D F! 2 42-r-S - 2 - 32- REQUIRED DEDICATION— FT — NAME I METER SIZE I LINE SIZE I NO. OF FIXTURES ADORES$ CITY ZIP ITELEPHONE NAME 6a� CBL III lot EBB loon (-)--eenujuoi9 /�,,e tQ CITY ZIP 1 TELEPHONE 0(0 - _�_R 9 STATE LICENSE NUMBER EXPIT'11ON DATE 13Y TP I NEW RESIDENTIAL VLUMBING ECH ANCEOR ADDITION COMMERCIAL 1:1 CHANGE OF USE REMODEL MULTIFAMILY 1:1 SIGN 0 REPAIR GRADING [3 FENCE CYDS X FT) DEMOLISH 0 TANK OTHER GARAGE [:3 RETAINING WALL F RE SPRINKLER CARPORT ROCKERY FIRE ALARM ME OF USE,. BUSINESS %L� �PLAIN: NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRI8E WORK TO BE DONE [�-_ . Dlacmc,�, n-\r4e I r- 4-,�,-j �nou.5-&_ REMARKS OWNER/CONTRACTOR APRESSURE FIRE REVIEWED BY LID FEE $ TESCP ed RW per=ired street use Peffnh PAqv Inspection Required Sidewalk Required UnderWound Wlftg required PRV REQUIRED YES 13 NO (3 AGE INSTALLM NEAR DATE DATE Ir, VARIANCE OR CU SHORELINE OR AD1111 I INSPECTION I BOND REO'D POSTED DYES ONO s SEPA REVIEW SIGN AREA HEIGHT COMPLETE EWM ALLOWED , PROPOSED _XP LOT CO E 'REQUIRED SETBACKS(ff) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR 52 PARKING LOTAR�A I PLANNING REVIEWED BY DATE PU�SUJV 06 RE013 PROVIDED A VS.A- - aM UPC 60-19-9 1 CHECKED BY JTYPW2��TION cjs�_ OCCUPANT GROUP K..3 SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [3YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION RECYD Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE T_5MFN0 % LOT SLOPE % Building ' Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AU1 AMRIZES ONLY THE WORK NCYTED. THIS PERMIT COVERS WORK TO t: BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC 2 Grading DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEII'ARATE PERMISSION. Engr. Review PEFIMIT APPILICATION: 180 DAYS PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WTTHIN 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 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 WHAME� NATURE, ANSIN13 DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF 7111S PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE DEEMED TO MODIFX OF ANY Landscape Insp. TOW Amt. Due ct�_ WAIVE OR REDUCE ANY REQUIREMENT CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee ece pt # I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION PPLIC ION 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 T I appikationis ot a permit until signed by the j61 4n 5 TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED er clalorhis rDeputy:and FeesarepaK and IN VIOLATION OF-.THkLABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION , a a It Is a , wledged in space proMed. WORKMENS CPUPENSAYJON INSURANCE AND RCW 18.27. -,, OF LAL GNAT ATE SIGNATURE R AGENT) DATE SIGNED 1U31 771-0220 I DATE ATTENTION EXT4BW- 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 L - z 0 M M C M C M M 0 _n n ITI M Fn C 0 z Z. 0 M