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20030522.pdfDATE RECEIVED 7/15/03 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS Dwight Thomas MAILING ADDRESS 21016 78th Ave W CITY ZIP TELEPHONE Edmonds 98026 425-776-2332 NAME ADDRESS CITY ZIP ITELEPHONE NAME ICBL# ADDRESS 16614 13-th AVe W CITY ZIP TELEPHONE Lynnwood 93037 425-775-6454 STATE LICENSE NUMBER X EIPI! ON DATE BY DAYMIPH044CM PROPERTY TAX ACCOUNT PARCEL NO. 00595800000800 NEW RESIDENTIAL PLUMBING I MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN REPAIR GRADING FENCE X CYDS FT) DEMOLISH TANK OTHER o GARAGE CARPORT RETAINING WALL FIRE SPRINKLER ROCKERY FIRE ALARM (TYPE OF USE, BUSIW§S OR A9rIVMfNjAjN: __ , , NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE Re-Pipa housa with naw 'Airsbo manai:old systan., plus inst new faucat out back of kit-chen (A -, A j In I - 9,94no-, HEAT SOURCE I GLAZING % I LOT SLOPE % PLAN CHECK NO: VESTED DATE a ----------------- ? I THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. pERMITAPPILICATION: ISODAYS PERMIT UMrr 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICAP9 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' I HEREBY ACKNOWLEDGE THAT I 14AVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECP 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 LAMODE OF THE STATE OF WASHINGTON RELATING TO N I WORKMEN'S COMF NI NCE AND RCW 18.27. DATE SIGNED 7/t, V/40 .7 _ I 1PERMITEXPIRES fil,riji/a. on�- USE PE MIT ZONE NUMBER JOB SUITE/APT# ADDRESS Of/ 79 A IJ 2:, 1 v e- PLAT NAME/SUBDIV[SION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Appr�vV MY Parnlit R uld Street Use Pennit Req'd EXISTING - PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION- FT r Iringrequired METER SIZE LINE Sl;�j NO. OF FIXTURES PRV REQUIRED OSE Rj NO 13 z REMARKS OWNER/CONTRACTOR RME11 , V&MOMM"AGE T�NA�MVAL4A ^rjriL,�Xj" REVIEWED BY DATE FIRE REVIEWED BY IIJ ECDC 19686.020 to VAI N"PrPRV) VARIANCE OR CU SHORELINE OR.i%DB#, IN SPECtION BOND REQ'D I POSTED 13YEs 13NO $ SEPA REVIEW SIGN AREA HEIGHT EXEMPT_ ALLOWED PROPOS ED ALLOWED PROPOSED EXP . q , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACK$ (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR w;oGgs -Opp siple, ,11111 F4 MKING LOT AR UARNM Aft 916 REO'D I PROVIDED I SMVICH SM IMIM I REMARKS LwE As rr mms nm joitnDiNa , I CHECKED BY TYPr Ur Ut., V A "* P GRO SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0 Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge / Llf� Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Depos Fire Inspection Receipt # Landscapeinsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION IIA-05) k-TIr- 771-0220 APPLICATION APPROVAL This application is not a permit until signed by the Building otticial or his/her Deputy: and roes are paid and receipt lsycknovAedgod in space provided. OFF WIVa' SIG URE DATE 12 -71i �70 I!REF�EAS D B DAtE ATTINTION t:A 1 1 Jj IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI- 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 j 0 M M rn 0 C M 10 C 0 n m Fn C pu rl rl 0 rD ,�DATE RECEIVE 7/1510 PERMIT EXPIRES , . USE, PERMIT 0 C�4� CITY OF EDMONDS '20NIE NUMBER '.., Ak-A CONSTRUCTION ERRAIT APPLICATION JOB SUrTEIAPT# ADDRESS OWNER NAMEINAME OF BUSINESS L PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. Dwiant Inomes MAILING ADDRESS 21016 78th Ave W CITY ZIP TELEPHONE Edmonds 98026 425-776-2632 NAME ADDRESS CITY ZIP ITELEPHONE NAME - ICBL# ADDRESS 16614 13th AVe W CITY ZIP Lynnwood 98037 FTELEP5HONE 42 425-775-6464 STATE LICENSE NUMBER EXPI ION D E X8_601414 BY DAYNIPH044CM PROPERTYTAX ACCOUNT PARCEL NO. 00595600000800 NEW RESIDENTIAL PLUMBING I MECH ADDITION 0 COMMERCIAL COMPLIANCE OR CHANGE OF USE he -If Ilk REMODEL, 0 MULTIFAMILY 0 SIGN REPAIR C] GRADING [3 FENCE X CYDS FT) DEMOLISH TANK 1:1 OTHER EGARAGE l CARPORT RETAJNINGWALL FIRE SPRINKLER ROCKERY FIRE ALARM (ME OF USE, BUSINMS OR A NUMBER NUMBER OF CRITICAL DWELLING AREAS OF UNITS NUMBER STORIES I DESCRIBE WO� f0 Do DONE a _ ipe house with new Wirsbo manefold system, plus install now faucet out back of kitchen ( ) - 14Ae-Y 9) ki J'— 4j.,7j;-- � HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORtMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRivAirE PROPERTY ONLY. ANY coNsTnucrioN ON THE PU13UC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYSI MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPILICATION: ISODAYS PERUff UMfP 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 $HALL NOT BE DEEMED TO MODIFX.WA1VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CffY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVE 13 CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE 9WINER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CQNSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLjDYED IN VIOLATION OF THE LAPNP15;&DE OF THE STATE OF WASHINGTON RELATING TO WORKMEN$ COMPENSATIJ N I . LANCE AND RCW 18.27. DATE SIGNED qlo -7 LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TES=pr RW R suest Use PeErm-Rvocr'. EXISTING — PROPOSED InspecUon Floquired Sidewalt ReoW REQUIRED DEDICATION— FT Underground WkIngroquinO 13 METER SIZE LINE SI�E�, OF FIXTURES PRV REQUIRED 1 YES 13 NO 13 z_ REMARKS —M,, mues" -1 OWNER/CONTRACTCE".— TWAVB E ARTMD __ AtM-SIP110N REVIEWED BY DATE FIRE REVIEWED BY rUKNUANT TO ECDC J%K020 APRWUNRBGULAT0RVALVEa" _Q A T 1 1 VARIANCE OR CU SHOR5W BOND ' POSTED MN 113YES S O� SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR z DATE I PARKING PROVIDECt �WW A §AQ LINEASITENTERSIM CHECKED BY CM) uuu ITYF= ] GROUPZ�n SPECIAL INSPECTION AREA OCCUPANT REQUIRED 13YES LOAD REMARKS PROGRESS INSPECW0 PER UBC 108/FINAL INSPECTION RE0-0 �� 1-79,2fifto mv__ VALUATION $ Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection I Fire Review Pian Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION (425) 771-0220 EXT 1333 APPLICATION APPROVAL' This application is not a pemit untH Signed by the Building Official or his/her Deputy: and Fees are paild, and receipt 13)rcknowledged In space provided. 05VAL 8 G114TURE 1 DATE RELEASED BV' DAtE 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 INE