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20030424.pdfI DATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEMAME OF BUSINESS MAILING ADDRESS L I C, 17- C) CITY ZIP TE EPHONE C'A'N 0., N (L" 'i Lf 25-- 7 "i 02-4 AI NAME //U/4 ADDRESS CITY ZIP I TELEPHONE NAME CBL cc) �-\ S ADDRESS (00"I CLjlrL1,S CITY ZIP TELEPHONE ML., K,' I fgc� 2S - q -? o - 6 ( 7 If STATE LICENSE NUMBER EXPIRATION DATE I,, - BY 06t, IROP ou L NJ() 1:1 NEW RESIDENTIAL PLUMBING / MECH IADDITION 3 COMMERCIAL 0 COMPLIANCE OR CHANGE OF USE 13 REMODEL MULTIFAMILY SIGN REPAIR GRADING 13 CYDS FENCE I FT DEMOLISH TANK OTHER & k 1 GARAGE 3 CARPORT Ei RETAINING WALL ROCKERY F RE SPRINKLER FIRE ALARM (TYPE OF USE. BUSINESS OR ACTIVIRMY'EXPLAIN: h NUMBER NUMBER OF CRITICAL OF I DWELLING AREAS STORIES ), — UNITS tz NUMBER DESCRIBE WORK TO BE DONE f HEAT SOURCE I GLAZING % I LOT SLOPE % PLAN CHECK NO: z_ .--y /7 z I VESTED DATE ( 42:2 - c_f -.�) I THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT UMM 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 INDEMNIFX 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 MODIF4 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 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 VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN! S COMPENSATU)N4146"NCK AND RCW 18.27. $GNED V, / ( _ �� —�' z,- PERMIT EXPIRES USE PERMIT ZONEf V NUMBER JOB E/APT)K ADDRESS S-M PLAT NAME/SUBDIVISION NO. LOT NO. L�D NO. L D FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required 13 Street Use Permit Req'd EXISTING — PROPOSED inspection Required [3 Sidewalk Required REQUIRED DEDICATION- FT Underground wiring required C3 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO C3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE ru� W Ix lZ VARIANCE OR CU SHORELINE OR ADB# I IN )ECTION S' BOND K��tP7 REO'D 113YES )i� POSTED SEPA REVIEW SIGN AREA HEIGHT COM EXP LOT COVERAGE REQUIRED SETBACKS (FT:) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR z PARKING I LOT AREAI PLANNING REVIEWED 13Y REO'D I PROVIDED I Z3 M 16- 3 REMARKS CHECKEDBY I TYPE OF CONSTRUCTION.._____ I C-"— OCCUPAN GROUP _x/ SPECIAL INSPECT7107 FAREA OCCUPANT REQUIRED 0 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 A C3 I- II n1A VALUATION $ Description Plan Check Building Permit Pjuazw� Mechanical Grading Engr. Review Engr. Inspection FEE DescrIlWon FEE State Surcharge City Surcharge Fire Review Plan Chk. DeposA, Fire Inspection Receipt # Landscapelnsp. Total Amt. Due EEO, Recording Fe e Receipt # 20z APPLICATION APPROVAL CALL Th a application is not a permit until signed by the Buildin"o Official or his/her Deputy: and Fees are paid, and FOR INSPECTION receipt Is acknowledged in space provided. OFFICIALS SIGNATURE DAI(E (425) V" Sm-_0&_ Y) 771-0220 B R SED BY DATE EXT 1333 up ORIGINAL - FILE YELLOW - INSPEAOR7 PINK - OWNER GOLD - ASSESSOR C "AVlklf%— r- r%01=ia GREEN - ACCOUNTING ['A t z 0 1 0 M rn C M 0 0 C 4 C X M M Z IC) --I C co 0 -n In M M 0 a; 0 r- 0 In Q 0 171 X z CA z 0 1 0 ITI RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing ...................... Wall .......................... Pier/Porch ................. Retaining Wall ........... Sl ab Insulation .......... PLUMBING: Underground ............. Rough -in ................... Commercial Final ...... HEATING: Gas Test .................... Gas Piping ................. Equipment ................. Commercial Final ....... EXTERIOR SHEATHING NAILING .......................... FRAMING ........................ FIRST FLOOR FRAMING ... INSULATION ................... Floor Insulation ......... Wall Insulation ........... Ceiling Insulation ....... SHEETROCK NAILING ... SPECIAL INSPECTION ... MISCELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY .................. DATE RE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINtSS OA 0 LA J V, C V MAILING ADDRESS Fcflo CITY ZIP TELEPHONE 1� c� 0^ 0 LA Js 1'-/ 2 5— -7 ei 1/ 0 2 Q NAME IIUIA ADDRESS PERMIT EXPIRES USE ZONE/) J) 17 PERMIT V NUMBER JOB ADDRESS �.UJTE/j I 77� PLAT NAME/SUBDIVISION NO. LOT NO. L D NO. L:D FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required EXISTING PROPOSED Sir at Use Permit Rsq'd Ins;2on Required Sidewalk Required REQUIRED DEDICATION- IFT Underground Wiring required 13- METER SIZE LINE SIZE OF FIXTUF ES PRV REQUIRED 7NO, YES13 NO C3 z REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGF CITY ZIP I TELEPHONE se I NAME �T a C CBL N C) 0 S c (n ENGINEERING REVIEWED BY DATE ADDRESS —C FI RE REVIEWED BY DATE W CITY ZIP TELEPHONE cc 2S - 9 0 6, '7 1 VARIANCE OR CU` HOPIELINE OR ADB# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE BY REQ'D 10YES �-;fm POSTED 3 — Oct $ SEPA REVIEW SIGN AREA HEIGHT PROP 7!O1.17�tTIL NL R COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 1 /)00 EXP NEW RESIDENTIAL 1:1 PLUMBING MECH LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (Fr.) FRONT SIDE REAR PROPOSED SETBACKS (Fr.) FRONT URSIDE REAR ADDITION COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE z PARK ING LOT AREA LANNING REVIEWED BY DATE 13 REMODE L MULTIFAMILY 0 SIGN REQ'D I PROVIDED REPAIR FENCE GRADING CYDS 0 ( _ X _FT) REMARKS DEMOLISH TANK OTHER A e _7 F't I V _ _t H F A j 3 GARAGE CARPO RETAINING WALL F RE SPRINKLER ROCKERY FIRE ALARM 9YPE OF USE, BUSINESS OR ACTIVI711) N: (('0) NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRIBE WORK T 0 BE DONE /jr_ I 1 g�e go, I v- fCj ":.j eo A r CHECKED BY TYPE OF CONSTRUCTION --[70DE OCCUPANT GROUP SPECIAL INSPEC'n OCCUPANT REQUIRED [] YES LOAD 017 RE PFj!jQReSS INSPECTAS PER UBC I 08/FINAL INSPECTION REO'D 9 VALUATION I /1 /11 1 1 , 11) s4l -fnh' P - ko r ab Description FEE Descrl�Jon FEE P, I heck C 4 ell, 0 State Surcharge an , ff-AT SOURCE, GLAZING *,r— '�-4 LOT SLOPE.% f ku�fld'inlg Pirrinit city Suicharge 1�3 CK NO: VESTED DATE PAunb" L J, Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO PUBLIC t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE Grading :21 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPILI&�Oi� I�WAY 4 / T PERMIT UMM I YEAR - PROVIDED WORK IS START9WITHIN 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. Depcsi� ;�116;1() 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 SHALL NOT BE FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Arrit Di ie 0 I NOR LIMIT IN ANY WAY THE C11YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. Recording Fee Receipt # W 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 AUTHOR [ZED 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 the Building Official or hisihor Deputy: arid 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 COMPENSAPONINS1.1f,1ANC� AND RCW 18.27. OFFICIALS SIGNATURE I C3 NAT U R E 0 A DATq SIGNED (425) U 771-0220 MeASED BY DATE ATTENTION Off 1333 "I 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 - INSPEC�OR 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 t z 0 0 ITI --I -n a � a M C 11711 0 -10 0 C -4 C X M M z IC) C 0 M M a 0 0 C M 0 Z z 0) z 0 i 0 M