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20030436.pdfDATE RECEIVED, 1r) CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS I - 1121 A44Y-1- 1AAL4 .210 CITY ZIP TELfPHONE &�et,e77-1 kIA- Woff IN,26) z-107 —_3�qo NAME ADDRESS 51-05- UIr CITY ZIP LE TE PHONE zn--43 6] A�o -q5co NAME,00W_ ADDRESS PCITY zip TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY PROPERTY TAX ACCOUNT PARCEL NO. W-5867-000-021-ol 1 NEW RESIDENTIAL [3 PLUMBING / MECH 1 ADDITION 0 COMMERCIAL [3 COMPLIANCE OR CHANGE OF USE [3 REMODEL APARTMENT SIGN [3 REPAIR [3 GRADING CYDS FENCE X I _ _ Fri DEMOLISH 0 TANK [:3 OTHER o GARAGE CARPORT o RETAINING WALL ROCKERY RENEWAL (TYPE OF USE. BUSINESS OR ACTIVTM EXPLAIN: 4�,Y7 46z,—, — NUMBER OF NUMBER 00 DWELLING CRITICAL AREAS STORIES UNITS NUMBER 1(449 DESCRIBE WORK TO BE DONE L-i— �_119 1 PERMIT EXPIRES �4= j USE PERMIT ZONE NUMBE JOB SUITE/APT# ADDRESS.2 v PLAT NAME/SUBDIVISION NO. 70. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Approved RW Pamift Remiked at Use Permit Req'd EXISTING — PROPOSED Ingrectjon Ft6quired Sidewak Required REQUIRED DEDICATION— FT urlderarow-ld Wirlrig required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YESD NO 13 z REMARKS' I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 11 ENGINEERING REVIEWED/DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE OR ADBO INSPECTION I PBOND REO'D OSTED !�L -LVAP 7r [3YES [3NO 5 R IEW SIGN AREA HEIGHT **WkD PROPOSED MPL%� A r1. _ XEMPT LLO D . PROPOSED ALLO LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR PARKING LOT AREA jj��NING REVIEWED BY D17 RECVD I PROVIDED 'ay c, I ( , ­N%�, 02. CHECKED BY 17`;Y�P 0 �CONSTRU ION COM — OCCUPANT �4- M7 GROUP �zl/f SPECIAL INEJPECTOR AREA OCCUPANT REQUIREDIX YES LOAD REMARKS PROGRESS INSPECT11ONS PER UBC 108/FINAL INSPECTION REG'D VAWATION $ FEE A­xj_Q EA-1-5 A6Qd Plan Check _4:J63 HEXT SOURCE GLAZING % LOT SLOPE % J Building PLAN CHECK NO: VESTED DATE Plumbing c.2 Mechanical SZr2: THIS PERMIT AUT140RUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading Recording Fee 2 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE M SEPARATE PERMISSION. h Engr. Review City Surcharge 547 15 PERMIT APPLICATION: 111110DAYS CL PERMIT ILIMM I YEM - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection State Surcharge 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 Traffic Mitigation Plan Chk Deposit AND AGENTS FROM ANY AND Fire Review Receipt # 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amount Due 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.* Landscapelns PT Receipt # I I HERE13Y 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 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 AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED Building Olficial or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ��celpt is nA�ovdedgod in space provided. WORKMEWS COMPENSATIO��CE AND RCW 18.27. _ _ I I E DATE sm SIGNATURE (OWN GE DATE SIGNED 1`1125) 17&* 7 71-0220 E ED BY jfATE ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR 10/01 z 0 d 0 C m 0 C 3� K m z 0 M m 8 V5 o Fn C2 ic M F4 z z 0 -4 0 m s a RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS 1121 6C "i/ F—rr GVIA-LI .210 CITY ZIP TELEPHONE N25-) 1-107 -.gVql NAME ADDRESS 115;�5 CITY ZIP TELEPHONE �,/ �AVoof (4125) 6 7.9 - 1-15Z:70 NAME�� d,,;7/ w CITY zip TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY PROPERTY TAX ACCOUNT PARCEL NO. _X586 Z_ 1000 - 027-01 66 7-60-1) -625-C6 NEW [3 RESIDENTIAL PLUMBING / MECH. ADDITION rl COMMERCIAL [3 COMPLIANCE OR CHANGE OF USE REMODEL 0 APARTMENT [3 SIGN REPAIR FENCE [3 GRADING CYDS 0 X Fri .13 DEMOLISH [3 TANK OTHER GARAGE CARPORT RETAINING WALL 13 ROCKERY_______ RENEWAL OWE OF USE, BUSINE88 OR ACTMTY) EXPLAIN: NUMBER OF NUMBER OF DWELLING 7UNITS CRITICAL A EAS STORIES MBER DESCFU13E WORK TO BE DONE QoLjC4 'ou-m 6-03 1 6 Y-4: � C_� HEAT SOURCE - I GLAZING % I LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO h 13E DOME OH PRIVATE PROPERTY ONLZ ANY CONSTIRUCTION ON THE PUBLIC VAYS, WRQUEES, ETC.) WILL REQUIRE DOMAIN (CURDS. SIDEWALKG,DRM SEPARATE PERMISSION. PERMITAPPLICATION:- 111110DAYS PERMIT UMM I YEAR - PROVIDED WORK 18 STAMM WITHIN 190 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION ;APPUCAUr. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS N INTEREST, AGREES TO INDEMNIF% DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OFTH15 PERMIT. 18SUANCE 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.' USE ZONE JOB ADDRESS2 to�v PLAT NAMEISUBDIVISION NO. PERMIT EXPIRES PERMIT NUMBEI49W, LOT NO. SUITIVAPTO 61D NO. JLID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7FIFV . 11.1.0 Street Use Permit Ratild EXISTING. 'PROPOSED Uspecson Raq*ed Sidewsk RaqAtred REQUIRED DEDICATION— FT UnderarcuM wmgrtqwm METER SIZE LINE �IZE NO. OF FIXTURES PRV REQUIRED I I YESD NO E3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING FIRE REVIEWED BY VARIANCE OR CU SHORELINE OR ADB# I T_ . -1 � . — — REVIEW N IGN AREA LOWS EXEMPT I AL ED . PROPOSED DATE I lag: INSPECTION I BOND REO'D POSTED [3YES [3NO N,dEIGHT ALLO . PROPOSED LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED I FRONT SIDE REAR I FRONT LIR SIDE REAR PARKING I LOT AREA 1"NING REVIEWED BY D REO'D I PROVIDED I % a I -r CHECKED BY SPECIAL INSFEPTOR AREA REQUIRED [2j YES REMARKS PROGRESS INSPECTIONS PER UBC VALLIATION $ EE Z 0!2 — 4;1 — OCCUPANT GROUP ��, / 4 OCCUPANTh LOAD INSPECTION RECVD A I FEE Building ?5 11/2, Plumbing Mechanical Grading Recording Fee Engr. Review City Surcharge Engr. Inspection State Surcharge Traffic Mitigation Plan Chk Deposit Fire Review Receipt # Fire Inspection Total Amount Due Landscapelns P. I Receipt # .09 Z) 14�1r,,_ 9, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN! 18 CORRECr AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNERL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL This aprAlcation Is not a permit until signed by the 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 Building OtRcW or hieftwer Deputy: and Fees are paid, and r�"pt Is aSq"edged in space provided. WORKMENS COMPENSATION IV=" CE AND ACW 18.27. OFFICr ATE � DATE SIC)NED 1425) WAI_ , 77 " All 771-0220 0C to BY I DATE ATTENTIOA M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECT/OR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FM PINK - OWNER - GOLD -ASSESSOR 10101 z ITI M M 0 1711 1711 z Cf) 0-11 "n IT1 ITI a 7M 0 r* 0 IT! C M 0 X z z IT!