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20030517.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS <21'Ay' 14PAUK) k-1115 MAILING ADDRESS 4f, C75703 221's S(,L) CITY ZIP TELEPHONE �-VAG&71)45 V60ZO 1Vz-S'_M�6J6& NAME ADDRESS CITY NAME ADDRESS CITY STATE LICENSE NUMBER ZIP ZIP I TELEPHONE TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY 13 REPAIR GRADING CYDS DEMOLISH [3 TANK GARAGE IRETAININGWALL CARPORT ROCKERY (TYPE OF USE, BUSINM OR ACTWM EXPLAIN: 0 NUMBER fN �U� 0 F M OF OF OWE�LUNG STORIES UNITS DESCRIBE WORK TO BE DONE CBL # PERMIT EXPIRES USE PERMIT ZONE'V.Z Z NUMBER :OB ADDRESS SUITE/APT# ;57- 5 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE5GP Approved RW Permit Requited Street Use Permit R&q'd EXISTING - PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION- FT UrWifforound Witing requited METER SIZE LINE SIZE 7. OF FIXTURES PRV REQUIRED 1 YES13 NO El z REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I REVIEWED BY FIRE REVIEWED BY DATE DATE 11" VARIANCE OR CU SHORELINE ORADBII INSPECTION BOND 1IONDATE CHECKEDBY I REQ'D I POSTED I I E3YES & $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EX;;�T� ALLOWED PROPOSED ALLOWED PROPOSED I EXP PLUMBING ir MECH LOT COVERAGE REQUIRED SETBACKS (FT.) SIDE REAR PROPOSED SETBACKS (Fr.) LIRSIDE REAR COMPLIANCE OR ALLOWED PROPOSED FRONT '.2 _"' '11-- 7-!� I 1(4!� I 1 CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE� A SIGN REOD PROVIDED CIL 711 Oj 0:5 0 FENCE FT) X b REMARKS FIRE SPRINKLER FIRE ALARM HEAT SOURCE GLAZING % LOT SLOPE % T_ PLAN CHECK N VESTED DATE n 1� L_;2 I !i THIS PERMIT AUTHORIZES ONLY THE WORK&OTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC 2 U 3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REG IRE t: SEPARATE PERMISSION. PERMIT APPLICATION: 160DAYS PERMIT LIMM 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 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 91 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. - 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 WORKMENS COMPENSATION INSURANCE AND RCW 18.27. DATE SPNED j CHECKED BY ITYPE OF CONSTRU71ON CODE U1LX;UF PP2GROU SPECIAL INSPECTION JAREA OCCUPANT REQUIRED LOAD 13 YES REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REG'D-, VALUATION $ z9lk�rjj — f C"j, Y. I - Description FEE Description FEE Plan Check St ate Surchargel 21, 6 -a Building Permit City Surcharge Plumbing -7-) n Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt 0 Landscape Insp. Total Amt. Due :;26;94 af—'s-6 Recording Fee I Z-;�p CALL FOR INSPECTION 1A00% 771-0220 APPLICATION APPIAOVA�a2 This application is not a permit unfit signed by the Building Official or his/her Deputy; and Face ate paid, and receipt Is acknowledged In space provided. OFFICIALS SIGNATURE DATE rARELEA#941- ATIFEITION 1EXT 1 3 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Milk A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL * FI E YELLOW - II(SPE CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWN GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING 1 z C) M M 0 M 2 0 M M 0 Fn r_ M CO). ITI 0 z Q) z 0 IT! I ("JoDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS (�;o PY RxWK) Us MAILING ADDRESS 4?S703 2_1,�* SW CITY Zip I TELEPHONE z_f"0?1JW ff7020 Vz-rPr63,56 NAME ADDRESS CITY ZIP ITELEPHONE NAME G CBL N ;:�"` I `� I PERMIT EXPIRES USE PERMIT ZONEV2".f NUMBER JOB ADDRESS SUITE/APT# PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appraved RW Pomit Required Strom Use Pennit Rsqd EXISTING — PROPOSED Inspecdon RoquArod Sidewalk Required REQUIRED DEDICATION— FT UnderWound Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES13 NO 0 REMARKS' OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY DATE L_ X 5=� i2_1_1 z 4MIZ FIRE REVIEWED BY DATE CITY 11 ZIP 'ITELEPHONE I VARIANCE OR CU SHORELINE OR ADB# INSPECTION 13OND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY 0 REO'D POSTED I 113YES a & $ - SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMT ALLO:,W.EDPROPOSED ALLOWED PROPOSED _EXP , [3 NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE ALLOWED PRO P. REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) FRONT SIDE FROU, LIR SIDE REAR COMPLIANCE OR _�.,qCED 'REAR -1-15 /fit (U' ADDITION COMMERCIAL 13 CHANGE OF USE PARI ING LOT AREA PL�NNING REVIEWED 13Y D*TE IL REMODEL MUITIFAMILY SIGN RE PROVIDED .7 0 REPAIR 0 GRADING CYDS FENCE X ( — FT) REMARKS 0 DEMOLISH TANK [3 GARAGE RETAININGWALL F RE SPRINKLER CARPORT ROCKERY FIRE ALARM (ME OF USE, BUSIN PP ACTIVIITY) EXPLAIN: CHECKED BY ITYPE OF CONSTRU IION CODE OCCUP GROUF)t� V ;_7 F-1 NUMBER OF NUMBER OF DWELLING I CRITICAL AREAS j4)f__1fl I SPECIAL INSPECTION . OCCUPANT STORIES "n— UNITS NUMBER REQUIRED [:] YES JAREA LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REG-D q Description FEE Description FEE il.. Plan Check I State Surcharge F HEAT SOURCE GLAZING % LOT SLOPE % Building Permit /I 31 — .9 City Surcharge 1, PLAN CHECK VESTE13 DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK AarEo. THIS PERMIT COVERS WORK TO I: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading rSurcharg, 3 DOMAIN (CUFM, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE M SEPARATE PERMISSION. I: Engr. Review PER=APPLjcAv�m: isoDAys PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review-.-- Plan Chk. Deposit ;APPUCANT. N NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 0 -12 ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY -, :!L 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 CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt # 12 �zm I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAI 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- CALL This application Is not a permit until signed by the TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or hloer Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided. WORKMENS COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE SIGNATU OWR ��R E CATE S1.9NED (42 — 771-0220 1 ELE D D E kif ATM N Off 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 CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES Z 0 M M rn 0 C M M C _z 0) 0 _111 "n M M. Fn C 0 z 4 z 0 0 M