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20030485.pdf11 DATE RECEIVED 'I CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION IER.NAMEINAME OF BUSINESS MAILING ADDREIS (Z)D?- -- lal�- & - a - CITY ZIP TELEPHONE(4 z-, ebmom6s 1 NAME ADDRESS CITY ZIP ITELEPHONE NAME ICBL# CITY STATE LICENSE NUMBER PROPERTY NEW ADDITION REMODEL REPAIR DEMOLISH GARAGE CARPORT (TYPE OF USE, BUS ZIP RESIDENTIAL COMMERCIAL MULTIFAMILY GRADING CYDS TANK oRETAINING WALL ROCKERY OR ACTIVITY11 EXPLAIN: 0 PERMIT EXPIRES iLL2 USE PERMIT V3 r— ZONE NUMBER 04 JOB SUITE/APT# ADDRESS T1+ JNVe_ :�- PLAT NAMEISUBDIVISION No. LOT NO. LID NO. LID FEE $ TESCP AP PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW ParrrJt=ed Street Use Permit 1`160 EXISTING - PROPOSED InspecW0 Required 13 SidewalkRequired 13 REQUIRED DEDICATION- FT Underground Wiring required 13 METER SIZE LINE OF FIXTURES PRV REQUIRED YES 13 NO 13 REMARKS OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE V, ENGINEERING REJJW FIFE DATE -,,-A TEST MUST BE FIRE REVIEWED AM a %PbRTE &u AFFIDAVITS SHALL NOT P ONE 7 1! 13 -a VARIANCE OR CU 5114WINSPECTION BOND RATION DATE rhRn= BY REO'D POSTED n ell Ll I ((ffu) 113YEs 13NOIS 0 SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED AL LOWED PROPOSED , , I EXP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR COMPLIANCE OR z CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE SIGN REQ`D PROVIDED I I FENCE ( x FT) REMARKS OTHL &S FIRE SPRINKLER FIRE ALARM NUMBER NUMBER OF CRITICAL OF DWELLING AREAS ST( UNITS NUMBER DESCRIBE WORK TO BE DONE .1 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 (CUrIBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT LIMM I YEAR - PROVIDED WORK 16 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 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 CITTS 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 UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED WOXODE OF THE STATE OF WASHINGTON RELATING TO IN VI LATI N LABO URA� wo COM SATI URANCE AND RCW 18.27. DATErGNED T1GVTUW_(0WN R R _7 to CHECKED BY OE;10UFAN;��. G . N SPECIAL INSPECTION JAREA OCCUPANT REQUIRED Q LOAD REMARKS PROGRESS INSPECTIONS PER UBC 109/FINAL INSPECTION REO'D $ . I --- Description FEE Description FEE Plan Check I State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION IAII 1-925 771-020!20 APPLICATION APPROVAL This applicatlon is not a permit until eigned by the Building Official or his/her Deputy: and Fees are paid, and receipt 0 acknowledged In space provided. I QM_Cj1A WAT'URE D TE -1-1 _7&0� hELEASEDSY f DA* 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- 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 1 0 M :4:R co � M M __I§ 0 C �z M jo z 0 n MITI! 0—ca 0 0- Fn C M C) z 0 4 0 M bATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNERNAME/NAME OF BUSINESS MAILING�DDREJS CITY C— 6AA NAME ADDRESS CITY NAME --1 - %-.J - z;;i %J,-, 'I CITY bbmohl i� S STATE LICENSE NUMBr9 op ( ZIP T, ZIP TELEPHONE CBL N RP�6. ( a< - , I q 0 ZIP TELEPfiONE UZT) EXPJRATIONJDATE I CRECM BY 1:1 NEW RESIDENTIAL MECH 0 ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE 19 REMODEL MULTIFAMILY SIGN 1:1 REPAIR GRADING CYDS FENCE X FT) 1:1 TANK OTH?DEMOLISH E] 0 kl� GARAGE o RETAJNINGWALL F RE SPRINKLER CARPORT ROCKERY FIRE ALARM UWE OF USE. Bust OR EXPLAIN: NUMBER OF NUMBER OF DWELLING 2AREAS CRITICAL STI UNITS h NUMBER DESCRIBE WORK TO R DONE IV I J. N To 011 r%m-�t,,c 1i . lttLr,.� %71�"LPERMIT EXPIRES GSE ZONE PERMIT NUMBER JOB ADDRESS 10,92 SUIMAPT# Ave PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required EXISTING — . PROPOSED Street Use Permit Roq1d Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground Wring required 13 METER SIZE LINE Sii�7. I OF FIXTURES PRV REQUIRED YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE DATE FIRE REVIEWOBSIN By CIOU I - - - --D I I � -1-VIR _ I T makiffi 9: VARIANCEORCUI �CFU%m I BOND M mmul EQ'D POSTED S 13NO Is SEPA REVIEW SIGN AREA HEIGHT COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED. EXP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR PARKING LOT AREA PLANNING REVIEWED BY DATE REaD I PROVIDED I CHECKED BY TYM I N OCCUPANT 777) GROUP El SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [:] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION RECVD (7 T 4-7,Y-7—o hoz,&l L— T-eflo, , Z.'e"if _j* 9 tuina oj o-r 17w In ffwu VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing 017 __� L -7 7111 Mechanical THIS PERMIT AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Im BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 3 Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTE-D 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 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 FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt Due �.NOFI LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' 1 Recording Fee Receipt # 1, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION � fg-6 APPLICATION APPROVAL GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC CALL This application Is not a pefmh Until signed by the TION. AND IN DOING THE WD AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 'ODE Building Official or his/her Deputy: and Fees are paid. and L" IN V!QLATION 01 * HE AW1810 OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Ip acknovAedged In space provided. WOMNIS COM A SA URANCE AND RCW 18.27. [A ATUIE , (0 R R DATE[GNED 1425: I.V,16 A 0 _f 12 VARY I, rRELEAXSEDY -1 LO 771-02 120, If/W DA* ATTENTION EXr 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 00101 z 9 0 m :;:H ra � 0 M C m 4 0 C �m m m 10 C Z Cft 0 m m CO) C Fn r. 8i mo z 31 55 z 0 4 0 m