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20030450.pdf11 DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS WS. I)OP,67HY ?,-)EcK MAILING ADDRESS qj?8 20734h_T�A(r CITY ZIP TELEPHONE EWoA)2)3 qu,, NAME ADDRESS CITY NAME ZIP ITELEPHONE ADDRESS '42-9 krgI(L114A:D CITY ZIP Q,o 1<vKWLfWb 700-5 STATE LICENSE NUMBER AAA-MSC066a>W CBL N TELEPHONE '-/zs 803 EXPIRATION DATE 0:3/18 /0 q 02 00 [3 NEW RESIDENTIAL PLUMBING / MECH 1:1 ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE [3 REMODEL MULTIFAMILY SIGN REPAIR GRADING CYDS FENCE t X FT) DEMOLISH TANK OTHER EGARAGE RETAINING WALL FIRE SPRINKLER l CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACTINTM EXPW_N.�_ I I — 1 1. [PERMIT '7- I V EXPIRES - USE PERMIT ZONE NUMBER �m3 JOB SUITE/APT# ADDRESS 17) -7 " lot- ��62 PLAT NAME/SUBDIVISION NO. LOT No. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Appraved Aw Permit Required Street Use Permit Roq'd EXISTING — PROPOSED Inspection Roquired Sidewalk Required REQUIRED DEDICATION— FT — Underground Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YESM NO 13 z I REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 11 REVIEWED BY DATE FIRE REVIEWED BY DATE in VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND REO'D POSTED 13YEs 13NO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , I LOT COVERAGE 'I'R I "OrT Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSE01 0,F1 RFAJ� NT - RONT SIDE REAR f; 6 h4upT PAR%jW6D TVA it DATE RECID I . REMARKS NUMBER NUMBER OF CRITI L OF DWELLING AREA STORIES UNITS NUMB R IJ* DESCRIBE WORK TO BE DONE I —1 Ila - R-Ove- 'MO IVI Lk_" HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE 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 IJIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO 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 MODIFX 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSAT9 ,M"MkRANCE AND RCW 18.27. I DATE SI ED SIG eg, OWNER D%AGE;�� CHECKED BY 1� �CCTION JVR OCCUPANTffl--R GROUP SPECIAL INSPECTION AREA OCCUPANT REQUIRED [:] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D VALUATION $ 1 Description FEE Description FEE Plan Check State Surcharge Building Permit 16� City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection e7z= Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION 1A* %425) 771-0220 APPLICATION APPROVAL This application Is not a permit until signod by the Building official or histher Deputy: and Foes are paid, and receipt Is acknoviriodged In space provided. 9jELWLjSS41G: JRE DATE - (NL F -P� - 0 REL —EASED VY f DATLe ATTXSITION 1 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I— 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 D4/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING it L.. FINAL PROJECT APPROVAL FORM z 9 0 m =i 9 vi ;j OM c Ma 0 80 c -4 r. MM M4 Z 0 -n n m M 055 0 o Fn C (j) m V) M 0 Z r- .AT ;a z 0) z 9 0 m 0 (:rDATE RECEIVED PERMIT EXPIRES USE PERMIT CITY OF EDMONDS ZONE NUMBER JOB ITE/APT# CONSTRUCTION PERMIT APPLICATION ADDRESS q) �� , OWNER NAMEINAME OF BUSINESS &7" F_ ftA tZ —i-N- PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. RO I MAILING ADDRESS qj?8 20:14h_;�.A(-C, SW CITY ZIP I TELEPHONE E--r*vf o Aj:D-n %oz4 1926 i-�Lic qz(W NAME ADDRESS lqffili NAME ZIP I TELEPHONE i94A ADDRESS '42-9 CITY ZIP VK1<cA&)b 780-5 STATE LICENSE NUMBER APA7MSW6&D0/ PROPERTY TAX -ACCOU N-T. PAaQEL.NO. CBL N fAy - 1 /0' TELEPHONE '426 80 3 30U, EXPIRATION DATE CYSCR'Q B� C>3/ 18 /" It.) I O�� 4�3 00 NEW JXRESIDENTIAL PLUMBING / MECH 0 ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL 0 MULnFAMILY 0 SIGN REPAIR GRADING CYDS FENCE 1:1 ( X FT] DEMOLISH IS TANK [3 OTHER GARAGE CARPORT -1 RETAINING WALL 1:1 ROCKERY FIRE SPRINKLER FIRE ALARM (TYPE OF USE, BUSINESS OR ACTIVITY) EXPIAft- ,I LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP AppnYiOd RW Per" Required suset Use Parnift Ro0ld EXISTING PROPOSED imp -don Required SIdewaW Required REQUIRED DEDJCATION— FT underground Wiring required METER SIZE LINE7'61ZE NO. OF FIXTURES PRV REQUIRED C9 YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE us cc Iz VARIANCE OR CU SHORELINEORADBO INSPECTION BOND REO'D I POSTED I 13YEs 13NO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , I LOT COVERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE S% FRONT LIRSIDE REAR -- I _V_&�Lno PARKING VV&ZWJMVEb M ATE REQ`D PROVIDE 4tjpSaa _hrmov OR CAP' I .j AL, NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER �J* DESCRIBE WORK TO BE DONE I APsma-Dw—ita- 4T SOURCE GLAZING % I LOT SLOPE % CHECK NO: I VESTED DATE THIS PERIMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN JCURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, IETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMirr umm i YEAR - PROVIDED WORK IS STARTED WTTHIN 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 C17YS 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEWS COMPEN:=RANCE AND RCW 18.27, BIG WNER 0 GENT) DATE 81 ED ?uRf (O�� f I � " X_'33 t CHECKED BY SPECIAL INSPECTION JAREA REQUIRED [] YES REMARKS PROGRESS INSPECTIONS PER UBC I OCCUPANT GROUP OCCUPANT LOAD INSPECTION REG',D 2 FEE Descirlption FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection 7Z—_ Receipt # I . Landscapelnsp. Total Amt. Due I. —I Recording Fee Receipt # CALL FOR INSPECTION Ido 1425) 771-0220 EXT 1333 APPLICATION APPROVAL This application Is not a permit until signed by the Building Officiall or hi3llw Deputy: and Feas are paid, and receipt Is w*n&Modged In space provid3d. 9_M=s'48IGNfTURE TE A.- �; I i IN ck� 6&1 RELEASED BY ............. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLON-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