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20030451.pdf0 0 1[11�_ DATE RECEIV 0 1 � ta CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS 4 _-4- MAILING ADDRESS NAME ADDRESS CITY NAME — ti\t12I1II ADDRESS (C CITY STATE LICENSE NUMBER ZIP TELEPHONE ZIP ITELEPHONE Ave - ZIP TELEPHONE 11 Q1 -11 CBL - 1, -Aq-1 I irmNEW 0 , ADMTION V-RESIDENTIAL 0 COMMERCIAL %_PLUMBIN:j� �ECH COMPLIAN CHANGE OF USE 1:1 REMODEL MULTIFAMILY SIGN 11 REPAIR GRADING CYDS FENCE X FT) ( 11 DEMOLISH TANK OTHER IGAFIAGE 3 CARPO RETAINING WALL ROCKERY F RE SPRINKLER FIRE ALARM _0 I PERMIT EXPIRES' USE PERMIT ZONE - W51 NUMBERa03 JOB lk \ Ct :5 'A-) SUiTE/APT# ADDRESS PLAT NAME/SUBDIVISION NO, LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP AP 'ZV Rw PernVtPR Iled EXISTING - PROPOSED Street Use Parinh Req'd Inspection Required Sidewalk Required REQUIRED DEDICATION- FT - Underground Wifing required METER SIZE LINE SIZE NO, FIXTURES PRV REQUIRED 4 YES 13 NO 13 z 15 REMARKS OWNER/C ONTRACTOR RESPONSIBLE FOR EROSION CONTROLJD� NAGE I I GAS PIPE TEST MUST BE OBSERVED BY CITY INSPECTOR At REVIEWED DATE FIRE REVIEWED BY DATE N." VARIANCE OR CU SHORELINE OR ADBI I INSPECTION 1$ BOND REO'D POSTED 13YEs ONO SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 44TE L vent connectors (TYPE OF USE, BUSINESS OR A N: NUMBER NUMBER OF CRITICAL o AREAS F DWELLING STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE VairtC_& &tW- I %j I ON 'CUPANT CHECKEDBY ITYPEPFP? OC Ir OF M SPECIAL INSPECTION JAREA OCCUPANT REQUIRED 0 YEs LOAD REMARKS PROGRESS INSPECTIONS PER UBC IQ$/FINAL INSPECTION REOM VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE -T—GLAZING % LOT SLOPE % Building Permit City Surcharge 16f2 PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURDS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr, Review PERMITAPPILICATION: 180 DAYS IL PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED MTHIN ISO 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 WHATEVER NATURE. ARISING DIRECTVY 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 CnYS ABILITY TO ENFORCE ANY ORD14ANCE PROVISION.- Recording Fee Receipt # HERE13Y ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION; THAT THE INFORMATION AP U ATION APPROVAL .,l 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- T CALL Ii It Is not a permit until signed by the loc.111t, TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Sul 1 Ript 0 his/her Deputy: and Fees we paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION acknowledged Inp pace provided. WORKMEN-S,PQMEENSATION INSURANCE AND RCW 18.27. :;;2& DA SIG NER PR AGENT) ATE IGNED 1A '35) %-WK- MZZA, , �T k4_.) 0 771-0220 114 ATE REL BY A7TENTION EXT 1333 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 z 0 q 0 M �14' DATE RECEIVID I CITY OF E;MOND"S' CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS W,.jAe_r- A eu*t'N C-M MAILING ADDRESS ZIP ADDRESS - RGR-al 'I I CITY ZIP ITELEPHONE PERMIT EXPIRES4L 4�-'j USE PERMIT ZONE NUMBERa03- 01-/9 JOB -1%\9 65-t �1 :5 SUITE/APT# ADDRESS PLAT NAME/SUBDIVISION N LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approv RW ked PenTal RaqV Street Use Permit Req'd EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground WWmg required 13 METER SIZE LINE SIZE NO. 0 FIXTURES PRV REQUIRED YES 13 NO 13 BE z REMARK OWNER/ So —0 - wm r r c - -ft- - W__ - -ff- -0. W. NAME CBL# '1W ;-4- =Omps. �_' - ENGINEERING REVIEWED BY DATE DRESS Uac, —FIRE REVIEWED BY DATE CITY ZIP TELEPHONE q%��s STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADEIN INSPECTION 13OND REO'D POSTED I 1$ I,— �17 GA-4- L r, c') OYES 13NO BEIRA REVIEW SIGN AREA HEIGHT PRQEERTY PAR COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , NEW d-RESIDENTIAL PLUMBING ECPH 12� 1 �_4 A OWED IRV 1-111EQUI EEDSETBACKS(�T) PROPOSED ETBACKS(FE) J�(ff Cbft&"rS FRONT LJ SIDE REAR COMPLIAN 1(:! 0 TM %Sf ADDITION COMMERCIAL CHANGE OF USE EIA REMODEL 0 muLnFAmiLy SIGN R N(8T31.EjVfP BY ATE REPAIR GRADING FENCE CYDS X FT) REk*RKe---- DEMOLISH TANK OTHER o GARAGE RETAJNINGWALL FIRE SPRINKLER 0__ROCKERY_ PORT FIRE ALARM (IYPE OF USE, BUSINESS OR A,; CHECKED BY OF lt?TRLICT(PN OCCUPANT ITYPE U GR li2 NUMBER NUMBER OF CRITICAL OF DWELLING AREAS L - - SPECIAL INSPECTION AREA OCCUPANT STORIES UNITS NUMBER REQUIRED [:) YES LOAD DESCRIBE WORK TO BE DONE �C'rc'tk REMARKS !PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D OL 7to 0� L %j k�&aA_ (� a 1 sc "Furoxc— C- Cop op + I 11mmul 6 1 E-1 VALUATION 11-6be I bmbf Description FEE Description FEE.. Plan Check State Surcharge HEAT SOURCE j7_G_L;7N_G % LOT SLOPE % Building Permit ojo' City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERUrT AUTHOR&MS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PFUVATIE PROPERTY ONLY. ANY CONSTRU07ION ON THE PLIBILIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATIOW. 180 DAYS PERMrT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 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 CRY OF EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, APJSING DIRECTLY OR RIDIRECTILY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. 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 # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLI ATION APPROVAL 'U GIVEN IS CORRECT, AND THAT I AIM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC. CALL Is not a pannit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED BUIM11011P1.1w hisiber Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 14PIVI acknowledged inppace provided. WORKMIENI��ENSATION INSURANCE AND RCW 18.27. owvl>�, DAT I SIGNATUR� (OWNER PR AGENT) O�TE[GNED V_0`25 9r W�J;iak_ /,/" IT 'RELYSId-By 771-0220 - ' - I DATE ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN& - 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