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20030547.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER N NAME OF BUSINESS A2)ME1 Z — R; MAI'll' - ADDRESS I '... ... 6 52 A, e— IV 7g 612 6-1 CITY ZIP TELEPHONE NAME ADDRESS CITY \-111 ZIP ITELEPHONE NAME 1CBL ADDRESS- 6CII /Vft CITY ZIP TEI�EPHONE 4& (( � �e --, lo-"< - L STATE LICENSE NUMBER EXPIRATION DATE CH�� 1-4." ;;?�2'& C- -71,1176W �22 '[PERIMITEXPIRES Uqk PERMIT ZONE NUMBEROM %g- — & e JOB SUITE/APT# ADDRESS MINE 67 � PLAT NAME/SUBDIVISION NO, ssssi�2 LOT NO. L�D NO. L D FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IIE Ap SCF1.1 R 11. RW street Use permit Req'd EXISTING - PROPOSED- Inspection Required 13 Sidewaik Required 13 REQUIRED DEDICATION- FT I Undororound Wiring rsquirod 0 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 1 I YES Cl NO 13 z REMARKS I z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BOND REO'D POSTED 13YEs ONO $ PROPERTY TAX ACCO NT PARCEL NO. SEPA REVIEW SIGN AREA COMPLETE EXEMPT ALLOWED PROPOSED HEIGHT - ALLOWED PROPOSED EXP , , I NEW 000'RESIDENTIAL 0 PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR 2 ADDITION COMMERCIAL COMPLIANCE OR 13 z CHANGE OF USE ri REMODEL 13 MULTIFAMILY [:1 SIGN PARKING LOT AREA REVIEWED 13Y DATE REOD PROVIDED REPAIR GRADING 0 rj FENCE CYOS L-J _ X _FT) REMARKS DEMOLISH 1:1 TANK E-4 6M A r [3 GARAGE [:] RETAINING WAI I f-RE SPRINKLER CARPORT ROCKE FIRE ALARM OWE OF USE, BUSINESS OPIV� EXPLAIN: CHECKED BY TV N OCCUP:A�N� 1699 -- Z., GR NUMBER OF STORIES NUMBER ISO DWELILING CRITItAl. AREAS CIALINSPECTION JAREA OCCUPA... NUMBER REQUIRED [3 YES LOAD DESCRIBE WORK TO BE DONE REMARKS 44-f- PROGRESS INSPECTIONS PER UBC 106/FINAL INSPECTION REQ'D VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE - GLAZING % I L6"LOPE % Building Permit ;r i — City Surcharge PLAN CHECK NO: VESTED DATE Plumbing THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical I= BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC 23 DOMAIN Grading (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPILICATION: ISO DAYS PERMIT UU[r 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 BE 91 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due z 0 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # r 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 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH C17Y 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 his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION is acknowledged In space provided. WORKMEN'S COMPENSATIO! AND RCW 18.27. �^Colpt _!3P!JRANCE 0 1 NAT DATE SIGNAT RE (0 DATE SIGNED (425) Cj 3 771-0220 RELEASED BY AITENTION 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- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE - YELLOW- INSPECTOR PINK -OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 4 0 m :i9i ra � am C 4 M- OC �c M 10 C 0 In � I MITI 5i Fn C 0 z 0 4 0 m 3m, PERMIT EXPIRES DATE RECEIVED UA PERMIT CITY OF EDMONDS ZONE NUMEIERC4�V:1_-4��)� JOB SUIMAPTO CONSTRUCTION PERMIT APPLICATION ADDRESS OWNER N SINE8S %MEINAME OF BU /,—c �Z-1__ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 15 MAILING ADDRES LID FEE $ S fEscl, Approved C-12 6� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerwA Required stnm use Pelmh Raqv CITY ZIP TELEPHONE EXISTING PROPOSED inspntion Required Sidnia0c Required UnderWound g.' I? REQUIRED DEDICATION— FT Weirigisquired 13 NAME METER SIZE NO. OF FIXTURES PRV REQUIRED YES13 No 13 ADDRESS, REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP TELEPHONE NAME CBL# A/ 4 '.' 4 C -I /' C<- � I ENGINEERING REVIEWED BY DATE ADDRESEr 601 '4'K" FIRE REVIEWED BY eeeeeeeege DATE Lu W CITY ZIP TELEPHONE M z VARIANCE OR Cu SHORELINE OR ADS# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHfjqKED 11 POSTED 2& REO'D I IE]Ycs 13NO $ _2_ ZU BEIRA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCO PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED, EXP LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.) NEW ff"RESIDENTtAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE PARKING G EVIEWED BY DATE 416 REMODEL muLnFAMILY SIGN REOD [PROVIDED REPAIR GRADING CYDS [3 FENCE X FT) REMARKS 0 DEMOLISH TANK oGARAGE, [3 RETAININGWALL fiRE SPRINKLER CARPORT ROCKERY E] FIRE ALARM (TYPE OF USE, BUSINESS OR A IVTM EXPLAIN: CHECKED BY ITY C ON OCCUPANT1,2 ;,V'/ "14 /1 GROUP "I NUMBER NUMIJIEROF' dRITIdAL DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT STORi UNITS NUMBER REQUIRED LOA OF ES Y DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SQURC�'� GL40NII 11 LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMrr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE On PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRftfEWAVS. MARQUEES. ETC.) INILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review PERMIT APPILICATIOlk 180 DAYS dL PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN'160 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHhLF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEPEND 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 PERMM ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapainsp. Total Amt. Due NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt # I HEREBY 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 COMMY 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 011111clal or histheir Deputy: and Fees we paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION �'Alkcalpt Is acknowledged In space provided. WORKMERS COMPENSATION INALPANCE AND RCW 18.27. 0' 1 I.GNAT�r.E DATE SIGNNAT,:E ZlrAll DATE SIGNED (425) C 3 771,0220 RELEASED BY ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLON - IN§PECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK-CN%NER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING t REE3 z 9 0 11711 M M 0 —10 0 C:: 52 C IT11 10 z 0 _n i2n 9 11711 M 8 V) In Fn C 0) C CO) M 0 X 0 z z 0 1 0 M