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20030537A.pdfM DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS 15 MAILING ADDRESS 140 ?31 _8 awl CITY ZIP ITELEPHONE NAME ADDRESS CITY ZIP TELEPHONE NAME _F-40 - ADDRESS CITY ZIP LiAqwavrl A& %Ix STATE"1110ENSE NUMBER 0-< F-cTo'claalel?N 11 CBL # c TELEPHONE 4449S — -776 - woo 0 NEW RESIDENTIAL 0 ADDITION 0 COMMERCIAL 0 REMODEL 0 muLnFAmv 0 REPAIR 0 GRADING CYDS 0 DEMOLISH 0 TANK 0 GARAGE 0 RETAININGWALL CARPORT ROCKERY (rYPE OF USE, BUSINESS OR A=jj NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE PLAN CHECK NO: PERMITEXPIRES USE PERMIT ZONE NUMBERZ103 —a �53_ JOB SUITE/APrT# ADDRESS %M-6r% i%—. PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE S 7ESCP Ap=ed PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw PerrM '"et Use Permit RGQV EXISTING — PROPOSED Inspection RoqL'ked Sidewalk Reclulrod REQUIRED DEDICATION— Fr UnderWound Wking rsq*W 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YEs[3 NO 13 z REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE is =-NGINEERING REVIEWED BY ( .. ECDC 19-MOV&v 'ULA"VALVH"O nDvvql Tps- RLG —_ --AV% FIRE REVIEWED BY SHALL BE 1N2i&xCC1W W TIM WA T13R SHUTOWE cc Ir VARIANCE OR CU SHORELINE OR ADSN INSPECTION BOND REO'D POSTED 113YEs 13NO $ SEPA REVIEW SIGN AREA,, HEIGHT COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED :XP PLUMBING/MECH COMPLIANCE OR CHANGE OF USE SIGN oFENCE ( _ _ FT) LOT COVERAGE REQUIRED SETBACKS (Fr.)., ALLOWED PROPOSE liffEW SPIMICE S*=_ :PROPOSED SETBACKS (Fr.) �4' LIR SIDE REAR iljffl�N " PARKING ZRBA REOD PROVIDE AS rrqNTMTHE I 94WAMME(WTHB)ATE BUILDING REMARKS OTHER FIRE SPRINKLER FIRE ALARM OE CHECKED BY TYPE OFCC� OCCUPANT 09 CRITICAL AREAS SPECIAL INSPECTION OCCUPANT NUMBER -1 REQUIRED [] YE JAREA LOAD % LOT SLOPE % VESTED DATE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 2 $ F Description -FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical THIS PERMIT AUTHORIZES ONIY THE WORK NOTED. THIS PERMIT COVERS WORK TO I: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 2 Grading 3 DOMAIN (CURDS, SIDEWALKS, DRMVAYB, MARQUEES, ETC.) WILL REQUIRE t: SEPARATE PERMISSION. Engr. Review PERMIT APPILICATION: 180 DAYS PERMIT 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 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 PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due I NOR umrr IN ANY WAY THE cays ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # 4el 1 HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL 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 applIcallon is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABqI6QODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMENS COMPENSATffINS"CE AND RCW 18.27. T I R E JWqW N E DATE GNED IA95) UWAII :OFMR�IN �UR SITIU S�L4� _71;(/03 771-0220 nATE RELEASED I 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 I p oik� 4 r T 40A USE ATE RECEIVED jj��j e3 I FPERMITEXPIRES U§E PERMIT CITY OF EDMONDS ZONE NUMBERZaO - 6 63 JOB sunVAPT# CONSTRUCTION PERMIT APPLICATION ADDRESS (OlLio OWNER NAMEINAME OF BUSINESS ez _11L PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. MAILING ADDRESS CITY ZIP ITELEPHONE NAME ADDRESS CITY ZIP TELEPHONE NAME CBL # f,40 00 ADDRESS a C)50,g S�,44A %Nj(�W, CITY ZIP TELEPHONE qvLs - -ra, co(.Co EXPIRATION DATE "0 Ict-, , I ;L;Lf3g (a1*A;%,W No tA SO PROPERTYTAX ACC01151TEARIZEL.N0. - A o2 m� j — �n sit NEW RESIDENTIAL ADDITION COMMERCIAL REM01DEL muLnFAMILY REPAIA GRADING CYDS DEMOLISH TANK [3 GARAGE RETAINING WALL CARPORT ROCKERY UWE OF USE, BUSINESS OR NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE: PLUMBING/MECH COMPLIANCE OR CHANGE OF USE SIGN FENCE x FT) [3 OTHER FIRE SPRINKLER FIRE ALARM ILiD FEE S PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP TESCP Appm"G RW Penrift RewhW sum use Permit RW EXISTING — PROPOSED I=R= REQUIRED DEDICATION— Fr UndwWmind WW9 mqWred 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES [3 NO REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING REVINVIDOWMITk' APkMTJREifi�VALVg" '"..hTT im NWR FIRE REVIEWED BY - To WATM SHMFF DATE I VARIANCE OR CU SHOSEUNE OR ADS# INSPECTION BOND REO'D POSTED MyEs ONO I S SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED . PROpOSFn I A" OWED . PROPOSED LOT COVERAGE ALLOWED PROPO PARKING REQ`D I PRC U, CHECKED BY TYPE OFJCOI� CRITICAL I W AREAS SPECIAL INSPECTION JAREA NUMBER PA-1 REQUIRED [3 YES HEAT SOURCE GLA23NG % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CUR13S, SIDEWALKS, DRIVEWAVS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PErISSION. PERMIT APP ;& -) w. PERMIT LIMM I YEAR - PROVIDEDtOR& SftT 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 "TURE, ARISING DIRECTLY OR INDIRECTLY FROM THE 184UANCE OF THIS.PERMIT.'q 186 . LANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY. VAA.IVIE OR REDUCE AW REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITV8 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 WTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL CE EMPLOYED IN VIOLATION OF THE LABQ"ODE OF THE STATE OF WASHINGTON RELATING TO WORKMENS COMPEN T)OFIANS-0,RANCE AND RCW 18.27. RE E11j;NA(�*N"T) DATE S GNED SSW 771a(/03 I SETBACKS (Fr.) IR SIDE REAR JOE IL OCCUPANT 109 GROUP OCCUPANT LOAD' REMARKS - .9 PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REGtD Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading q Engr. Inspection Fire Review Plan Chk. Depo Fire Inspection Receipt # Landscapeinsp. Total Amt. Due Recording Fee Receipt # CALL TWz application Is not a permit untill signed by the Building Official or hWher Dop*: and ROB We paid, and R INSPECTION receipt is &cknowlodged in space pr&Aded. 1A0 X-25) OFT )� ?S S/� 771-0220 L, RELEASED IR_ ( I DATE ATTENTION I 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- 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