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20030513.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS MAILING ADDRESS Z/6 S-,VV A*1,0 J�oz,71—,V CITY ZIP TELEPHONE 5-/90"iio�os LO I V,0- 77C OS%dY NAME 6 Y Y jr7--" *ic 5 _?&D _f;; -9/sj CITY ZIP ELEPHONE ez;i,ftw'05 f eoz-0 yg5- 77 NAME jCBLN ADDRESS L Z&07 CITY ZIP 'Wb7?, TELEPHONE jill zlirl I 70f STATE LICENSE NUMBER EXPIRATION DATE I CHF9KED BY QLz5-&."z21I* 'al-d8 r7cz 12 PAMPERTY TAX ACCOUNT PARCEL NO. - , 039) Z 7-3L) -co NEW RESIDENTIAL PLUMBING / MECH XCOMPLIANCE OR ADDITION COMMERCIAL JR- CHANGE OF USE REMODEL WMULnFAMILY SIGN REPAIR GRADING 0 FENCE CYDS ( X FT) DEMOLISH TANK OTHER ]GARAGE RETAININGWALL F RE SPRINKLER ROCKERY FIRE ALARM _CARPORT (TYPE OF USE. BUSINESS OR ACTIVIM EXPLAIN: -44Z NUMBER NUMBER OF RITICAL OF DWELLING 45 AREAS 1 STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK N 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: 160 DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCGESORS 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 CnYS ABILITY TO ENFORCE ANY ORDINANC7 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 C0jjE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INS .4(ANE5 A __WCW 18.27. SIC�inr(OWNER ORQAT)W DATE SIGNED _ , vlz T.'. - Im 14 —"'03 PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS Z4 ;F PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APPFOV*d AW Permit Required Street Use Permit R*q'd EXISTING — PROPOSED Inspection Requited 81 Sidewalk Required REQUIRED DEDICATION— FT Underground WIMg required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV 9EQUIRED 1 1 93 YES NO 13 35 REMARKS 21 OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE It -- J� - f /A) BY FIRE REVIEWED BY ///427! DATE M VARIANCE OR CU SHORELINE OR ADBN I INSPECTION PBOND OSTED 1REO'D 13YEs 13NOIs SEPA REVIEW SIGN AREA HEIG14T COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , , LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR I z BY DATE PARKING REO'D I PROVIDED i LOT AREA I PLANNING REVIEWED CHECKED BY NSTRUCTI ULAWFANI ITYPE /,//& GROupe SPECIAL INSPECTION JAREA OCCUPANT REQUIRED 0 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D Description FEE Description FEE Plan Check State Surcharge Building Permit city surcharge 16.- Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # APPLICATION APPROVAL This application Is not a permit until signed by the CALL Building Olficial or histher Deputy: and Fees are paid, and FOR INSPECTION receipt Is acknowledged In space provided. OFFICIALS SIGNATURE DATE IA95) %-Flr- W-V 771-0220 RELJ(ASQD BY /DATE AITENTION hxT 1 3 V) IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL LZZ A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES RIGINAL - FILE YELLON - IN91REC�0 PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING I z 0 M =i:% M NIS 10 0 C: �x M M 10 � 0 M M 0 0 FT, 0 z z M RECORD OF INSPECTIONS 0 p I I ALL.' 4 ::t4 N DATE RECEIVED DATE [PER�MIT EXPIRES A� h& USE ZONE PERMIT CITY OF EDMONDS geil NUMBER c4j�� JO SUnVAPT# CONSTRUCTION PERMIT APPLICATION ADDRESS OWNER NAME/NAME OF BUSINESS - N4!z ;F -!S- I M112 PLAT NAME/SUBDIVISION LID NO. I I K-9 1) D Af /7t.,*L /,t 172 MAILING ADDRESS 2 CITY ZIP TELEPHONE WOLO I VLS- 77�' 05'65� NAME V/ Azzr 5 153f-76-0 CITY ZIP TELEPHONE 5?, ?0 7— o 10.5'WFI_�_30 NAME ICBL# JP /Ais �e_ . LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approv9d AW P*rmn ReWifed Strget Use p-fmh PAr;d EXISTING — PROPOSED Inspeewn nequIred SidewakRoquired REQUIRED DEDICATION— FT UndwgrourW wiftgrequirk! METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED (3 I 1 2-41 YES 13 NO 13 z REMARKS — OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE /I e. ; ev.4� 1 J_ ,1AJ - o BY ADDRESS g�p_e� Ali- FIRE REVIEWED BY DATE CITY ZIP TELEPHONE 9?b 7 Z_ _111f VARIANCE OR CU SHORELINE OR AD1111 INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHFCKED BY REO'D POSTED I I 12-31-o3 I DYES ONO S SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 4:3 o ff -CO , , EXP NEW r-1:7E XPLUMBINGIMECt, LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0 ADDITION COMPLIANCE OR COMMERCIAL 13 CHANGE OF USE PARKING LOT AREA PLANNING DATE REVIEWED BY REMODEL WMULTIFAMILY SIGN RECVD I PROVIDED REPAIR GRADING FENCE CYDS x FT) REMARKS DEMOLISH TANK Ei OTHER GARAGE RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM 9YPE,OF USE, BUSINESS OR ACTIVITY) EXPLOYN: CHECKEDBY TYPE OCCUPPA� I GRO �F72STRUCTIO ,NUMBER OF NUMBER OF CRITICAL DWELLING AREAS SPECIAL INSPECTION OCCUPANT STORIES UNITS NUMBER REQUIRED [I YES JAREA LOAD DESCRIBE WORK TO BE DONE er2121REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NP: VESTED DATE THIS PER1111rT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE PERMTrAPPILICATIOM 1180NOY11% PERMIIT LIMM I YEAR - PROVIDED WORK IS STAF(TED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHhUF 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, AFUSING 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 01YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - I HEREIT0. DGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATIOtt GIVEN IS r4ORRE" 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 C0,9E OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION �NAPANEE.OELRMV 18.27. SIG RQTq57 ,!!��(OWNER 0 DATE SIGNED VALUATION Description Plan Check Building Permit Plumbing Mechanical Grading z 0 :1 0 M M C M 0 —40 10 C 31 C M ITI z 0 M M a @) 0 0 C CO) z il FEE Deacrlptl!t FEE z State Surch 1 --- 0 Ul) City Surcham;' M me 1 76 0 /1 1 Ir Engr. Inspection Fire Review Plan.Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # APPLICATION APPROVAL CALL This application Is not a parmit until signed bY the BWdInq Official or his/her DepUty: and Fees are paid, and FOR INSPECTION ovelpt Is acknovAedgod in space provided. OFFICIALS SIGNATURE DATE `7 1425) 771-0220 REL AS D BY /DATE I Al'TENTION EXT 1 33 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 YFI 1'aAf - IN!(PE CATE OF OCCUPANCY HAS BEEN GRANTED. UBC.SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 GREEN - ACCOUNTING PRESS HARD -YOU ARE MAKING 5 COPIES