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20030441A (2).pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWI��E/NAME OF BUSINESS3 MAILING ADDRESS A CITY ZIP TELEPHONE 8dm4o ktjs NAME E ADDRESS CITY ZIP ITELEPHONE NAME L# 444P.&A/ A nK cc ADDRESS CITY Zip TELEPHONE 62 7- XPIRATION DATE STATE LICENSE NUMBER &AI V I 1Z *r-5- Cr If/ Lk ary TAX. ACCOUNT PARCEL NO. PROPE 2ye V 10 30 40149 NEW RESIDENTIAL PLUMBING I MECH COMPLIANCE OR COMMERCIAL ADDITION CHANGE OF USE REMODEL MULTIFAMILY SIGN GRIPPG FENCE 0 REPAIR CYDS X FT) OTHER DEMOLISH TAN N =WL FIRE SPRINKLER GARAGE RETAINI CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACT"'Tw*4150 TV NUMBER OF CRITICAL NUMBER OF I I DWELLING AREAS RCA - STORIES UNITS NUMBE DESCRIBE WORK TO BE DONE Atf 1� & 'XcA oA_7TS& 1,a U-6 7- 4 OK ., / tfj /i r 1e, ~ vo 4 ------- 3 �Ic- �'* PIRES, FPERMIT EX USE PERMIT ZONE NUMBER JOB � �TE/AVV ADDRESS i 12- / 0 Tx 4��7 PLAT NAME/SUBDIVISION N;7LOT No. LID NO. LID FEE $ TESCP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Perwitt Required street use P4ffnft Raqd lroapectkin Required EXISTING PROPOSED— Sidewalk Required FT UWn, Mul 13 ddnwggrrsoq' REQUIRED DEDICATION r e d METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YESE3 NO 0 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE vkgp HEAT SOURCE GLaAZING% LOT. SLOPE % PLANCHECKNO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED- THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLI AjN'Y CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION - PERMIT APPLICATION: ISO DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 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 PERMTE 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 CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I HERE13Y 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 VIOLATION OF THE LA EE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSA� N �ISU NCE AND RCW 18.27. DATE SIGNED I 3 KIR =NGINEERING REVIEWED BY UAIC FIRE REVIEWED BY DATE Lru 6 6 VARIANCE OR CU SHORELINE ORADSM INSPECTION BOND REO'D POSTED 1$ 13YES 5<0 SEPA REVIEW COMPLETE EXEMPT 7 SIGN AREA HEIGHT ALLOWED PROPOSED . ALLOWED PROPOSED I EXP 1 __ LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR ----------- z z PARKING LOT ARE PLANNING REVIEWED BY DA TE REO'D FREMARKS jTypF.erpo I OCCUPANT ,NSVUCTION C?709.11. SPECIAL INSPEC—TION OCCUPANT REQUIRED [3 YES _JAREA LOAD REMARKS PROGRESS INSPECTIONS PER UBC JOB/FINAL INSPECTION REGVO 9 1 $ --.i Description FEE Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Description FEE State Surcharge City Surcharge Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp-T 37ue Total Amt. Due Tot I t. PA15 Recording FeeT Receipt # APPLICATION APPROVAL CALL I This application is not a permit unfil signed by the Building Official or his/her Deputy: and Fees are paid, and FOR INSPECTION receipt Is acknovAedged in space provided. _ 2-5) nari O�FFICIALS SIGNATU:RE 03 (A. 771-0220 RE ED BY, DATE CVT .1 ATTENTIOW STRUCTURE UNTIL IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW INSPECT 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 6 a k'r ptiit. i-, 13 'DATE RECE USE CITY OF EDMONDS ZONE I Inn I _PERMIT EXPIRES PERMIT C7& NUMBER CONIS I RUC I ION PERM111 J%r L1UJ4 IlUri ADDRESS WIT OWN EINAME OF BUSINESST, s " 4 -0101 -4-1- PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. &!= OL MAILING ADDRESS / W64 root- 14 .1 A&/ CITY ZIP TELEPHONE gEdt"j kj 1.7/j /, j 1 Y 2-C - d' NAME ADDRESS CITY ZIP ITELEPHONE j 4­ NAME EK 0 1 .44 4P,& A� -n/<' Y4f-,t*'-e CBL # ADDRESS JUlad 57-. CITY ZIP 9. TELEPHONE 2,46 - 12Z� - 60,,V-0, STATE LICENSE NUMBER EXPIRATION DATEr� _97A101A aft/ "KE PR!FQLY TAX ACCOYNT PARCEL NO. eno ale2 claq op 0 NEW XRESIDENTAL PLUMBING/MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE [3 REMODEL 0 MULTIFAMILY SIGN 13 REPAIR G G FENCE CYOS 11 X FT) [3 DEMOLISH TTAN;&60M 4, OTHER [i GARAGE CARPORT [3 RETAINING W0Uj ROCKERY FIRE SPRINKLER FIRE ALARM (TYPE, OF USE, BUSINE88 OR LID FEE S TES�=Ved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Ited Strom Uss Permit Wd EXISTING PROPOSED — I Inspection RequkW SWwa* RoWired REQUIRED DEDICATION- FT WIringroqulmd Undorgpr000d METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE __I> A FeA JZV INSPI-0104 Of _Wjlz� - ENGINEERING REVIEWED DATE FIRE REVIEWED BY DATE 1 1 IEL VARIANCE OR CU SHORELINEORADSM I INSPECTION BOND REO'D POSTED OYES ii<0 IS SEPA REVIEW SIGN AREA - HEIGHT COMPLETE I EXEM!�ej ALLOWED I PROPOSED [ ALLOWED I PR ED LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)' ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR PARKING LOT AREA PLANNING REVIEWED BY DATE RECI`13 I PROVIDED REMARKS C1,001 M C_ HE KED CHECKED BY C C BY TYP P7 !REA I L—NIJER NUMBER NUMBER OF CRITICAL WA I V 0 0 F TORIES S 13TO 1 8 DWELLING NITS AREAS _ CA - 63- CTI SPECIAL INSPE ON REQUIRED [] YE S DESCRIBE WORK TO BE DONE 'I M REMARKS PRO.RESS INSPECTIO1 I&JL,t'a (A67- 4 OKI( e- <d A C pe HEAT SOURCE % LOT SLOPE % iUCTION OCCUPANT -GROUP ow OCCUPANT LOAD PER UBC 1108/FINAL INSPECTION REaD Description FEE Plan Check Building Permit cin Description ­-1FEI State Surcharge City Surcharge PUMCHECKNO: jwi—z VESTED LIAIIE Plumbing 'dech'allical THIS PERMIT AUTH11DftES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO 13E DOKE ON PRIVATE PROPERTIf ONLX ANY CONSTRUCTIOW ON THE PUBLIC Grading DOMAIN (CUMI% SIDEWALKS, DRNEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PEFUSSION. Engr. Review PERMIT APPILICATION:* ISO DAYS PERMIT ILIMM 1 WAR - PROVIDED WORK 18 STARITED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION "APPLICAff, 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 EDMC&DMS� WA8HINGTO1,1 ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND FIre Inspection Receipt # ALL C FOR CAMAG a OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. 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." Recording Fee Receipt # 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECr 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 TWs sWicaWn Is not a poffnIt until signed by the TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Oftlal or hlOer Deputy: and Fees are paid, and IN VIOLATION OF THE LAEPW-COVE OF THE STATE OF WASHINGTON ..RELATING TO FOR INSPECTION receipt is acknowledged In space provided. WORKMEITS COMPENSA ,VON INSUF"CE AND RCW 18.27. OFFICIALS SIGNATURE t V03 SIOLVE AGEN"T) DATE SIGNED —25) I 771-0220 RE ED BY DAtE ATM 1010 Off 1333 AJ IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Jf­ay�/, A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI� ORIGINAL -FILE YELLOW. INSP"ECT04 CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING