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20030552.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS AILING ADDRESS yJ CITY ZIP TELEPHONE k0HWTd VJA CW-V�(C '42-57 4:�_'7 2-4 4 4 NAME ADDRESS CITY ZIP ITELEPHONE X. CBLN ADDRESS r) PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS 7/10 ee��M' PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Permit RWd EXISTING — PROPOSED Inspection R*quired [3 Sidewalk Raqui(ed 13 REQUIRED DEDICATION— FT UndeVmirid Wiring required METERSIZE___j LINESIZE NO. OF FIXTURES I PRV REQUIRED YES C3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE ENGINEERING REVIEWED BY DATE 411L-jr W'V L FIRE REVIEWED BY DATE Lu CITY ZIP TELEPHONE III I VARIANCE OR CUI SHORELINE OR ADB# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION CHECKED BY REQ'D POSTED I 113YEs 13NO $ _ _ SEPA REVIEW SIGN AREA HEIGHT PROPERTY -TAX -ACCOUNT PARCEL NO. III COMPLETE . EXEMPT I ALLOWED , PROPOSEn I ALLOWED PROPOSED NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL LIFI&C/ 0 REPAIR 0 GRADING CYDS [:] DEMOLISH TANK oGARAGE CARPORT RETAININGWALL __13 ROCKERY (TYPE OF USE, BUSIN ACT LAIN: NUMBER OF NUMBER OF DWELILING JNP- STORIES UNITS DESCRIBE WORK TO BE DONE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) 2211LUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRON T UR SIDE REAR COMPLIANCE OR CHANGE OF USE I I PARKING LOT AREA I PLANNING REVIEWED, BY DATE SIGN RECID I PROVIDED FENCE ( X FT) REMARKS 0 OTHER FIRE SPRINKLER FIRE ALARM CHECKED BY JTYP�� U NT I C& OCC PA GROUP RITICAL AREAS SPECIAL INSPECTIONT-UA—REA OCCUPANT NUMBER REQUIR LOAD ED YES ]REMARKS I PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D i We, YA34+ i 1,11 Z_U-61� I I C.&.27-rm, $ L Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO- VESTED DATE Plumbing Mechanical THIS PEnM1rT AUTHORCES ONLV THE WORK NOTED. THIS PERMrr COVERS WORK TO BE DONE ON PRWATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, BIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPUCATION: 180 DAYS PERMIT UMM I YEAR - PROVIDED WORK 19 STARTED WITHIN 160 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 ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt # FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 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 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 ALMIORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO Building Offlcial or hl0er Deputy: and Foes are paid, and FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSATYfM?�URANCE AND RCW 18.27. OFFICIALS DATE SIGNATU "JOW OR E DATI SIGNED (42511 jhwl; 771 -0220 "SIG;NATURE E E By DATE 4TTEFTION EXT 1333 ;' ; X 0 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I i 4if/retwouf k 44 C-- --,I A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- V � O�IGIN -FILE YELL& -INAPFITO CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINX01WNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING ni t, ivol, t?4' ,$.!. 0 -.0 RECORD OF INSPECTIONS m RECEIVED 4-1 - --- 7 1 ` I CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESP MAILING ADDRESS CITY k mwff� W) NAME ADDRESS CITY N ME A ? ADDRESS CITY STATE LICENSE NUMBER dtywaw NAH luvd ZIP TELEPHONE f,7 4 ?-57 V7 v -17-4 4 ZIP ITELEPHONE 040' ZIP I TELEPHONE [] NEW RESIDENTIAL. 13 ADDITION COMMERCIAL 'El REMODEL U&Omue' 13 REPAIR GRADING CYDS 0 DEMOLISH'! TANK oGARAGE CARPORT [3 RETAINING WALL ROCKERY (ME OF USE, BUSINESS�R EXPLAIN: NUMBER OF NUMBER OF )WELLING STORIES UNITS DESCRIBE WORK TO BE DONE I 0 PERMIT EXPIRES USLW PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS PLAT NAMEISUBDI14SION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TIESCP Appr-W Rw PofnA Required Street Use Pofmh Wd EXISTING - PROPOSED inspection Required sid..' R=.,.d REQUIRED DEDICATION- FT UndrWaxid WiMg required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 z GE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE VARIANCE OR CUI SHORELINEORADSN I INSPECTION I BOND CHECKED BY REQ'D POSTED I SEPA REVIEW SIGN AREA OyEs 13NO $ HEIGHT COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED f� ArUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) k ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR COMPLIANCE OR 0 CHANGE OF USE PARKING LOT AREA I PLANNING REVIEWED BY DATE 0 SIGN RECID I PROVIDED FENCE FT) REMARKS OTHER FIRE SPRINKLER FIRE ALARM CHECKED BY JTYP!Z?�O OCCUPANT &#00' GROUP / CRITICAL AREAS SPECIAL INSPECTIOW AREA OCCUPANT OBER REQUIRED [] LOAD YES REMARKS PROGRESS INSgMM�S PER UBC 11081FINAL INSPECTION RE(ZD,, Vf, l4f i 0 41A151, IT :'� , .. I �4� � "N As K-> 110 1 Wr yI—)r1yy"r'r q �4rfr_l r-,-Vs VALUATION . . -1 ff CUIN $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % IBuilding Permit City S urcharge ; NDeescr'rpt PLAN CHECK NO, VESTED DATE Plumbing I - Mechanical THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t E DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 0 Grading Vq DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, FTC.) LL REQUIRE SEPARATE PERMISSION. Engr. Review PeRurrAPPUcAmON: ieoDAys PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION -APPLICANK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOW HARMLESS THE CITY OF EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND,, Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATqRE. ARISING DIRECTLY OR INDIRECTLY ' FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Receipt # Recording Fee 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 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 IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Officiall or Neftier Deputy: and Feez are paid, and receipt Is acknowledged In spisce provided. WORKMENS COMPENSAT)O)MMYRANCE AND RCW 16.27. OFFIC S SIGNATURE DATE SIGNATUR� 0 O;Rv DAT SIGNED V i'l-2-2-03 771-0220 ills XEfCAS D DATE ArMIATION EXT 1333 ,1 7, BY ?125' IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I 64(4oqddX-1r � 41 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- O_F�IGIN -FILE YELL&V - INSPdTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINVOWNER GOLD -ASSESSOR GREEN - ACCOUNTING 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES 11�111111r]