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20030565.pdfm DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION O�WNERNAME/NAME� SINESS tj P P SI MAILING ADDRESS NAME ADDRESS CITY NAME CITY 'Ok', V"-- L) ZIP ITELEPHONE to && jzj-'74�- 3 ZIP TELEPHONE 1CBLN ZIP TELEPHONE STATE LICENSE NUMBER PROPERTY TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL ADDITION COMMERCIAL E] REMODEL MULTIFAMILY REPAIR [3 GRADING CYDS DEMOLISH 13 TANK GARAGE [3 RETAININGWALL CARPORT ROCKERY UWE OF USE, BUS OR ACTIVITY) JEXPLAIN: 177851A NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE 7-/ �v Tir, r HEAT SOURCE CHECKED BY PLUM13ING if MECH COMPLIANCE OR CHANGE OF USE 0 SIGN M FENCE L_J x FT) FIRE SPRINKLER FIRE ALARM PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB ADDRESL�4i�� PLAT NAME/SUBDIVISION NO. NO. LD7 LID ES _JOT PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7 W F=9d RESP, Street Use Permit 1190 EXISTING — PROPOSED Impaction Required Sidewalk Required REQUIRED DEDICATION— FT UnderarcuM Wiring required 13 METER SIZE LINE SIZE I I NO. OF FIXTURES PRV REQUIRED ! YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE DATE FIRE REVIEWED BY DATE 10 M VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND . REO'D POSTED is DYES ONO SEPA REVIEW SIGN AREA, HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRON T LIR SIDE REAR PARKING I LOT AREA I PLANNING REVIEWED. BY D E REQPD I PROVIDED �/fZ_ CHECKED BY TYP6 OF C;0 OCCUPANT GROUP STRuenON I 'S CRITICAL AREAS SPECIAL INSPEC7 . ION OCCUPANT NUMBER JAREA REQUIRED [3 Yl LOAD REMARKS ROGIIESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D &AAF - 'd z VALUAOON _o0l $ Dewription FEE Descrl#ptlon FEE Plan Check State Surcharge LOT SLOPE % Building Per it M:d City Surcharge 4�_ PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO k: BE DONE ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBLIC X Grading DONLIUN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPLICATION: ISODAYS PERMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 150 DAYS Engr. Inspection SEE RACK OF PINK PERMIT FOR MORE INFORMATION ,T.ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit ;APIT rRE AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLJOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAJMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due 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.' Recording Fee Receipt # 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPMATION 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 Building Official or his/her Deputy: and Fees we paid. and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. CIALS SI NATURE DATE 1AA SIGNATURE 0 OR AGENT) DATE SIGNED 14,25) 1 _= �� , �� 71 -Vlo C-1 771-0220 -TELEAF se's I AWE'NTION 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 0 DATE RECE DATE RECEIVED LP.ERMIT EXPIRES CITY OF EDMONDS .USE PERMIT ZONE NUMBER n1ftir CONSTRUCTION PERMIT APPLICATION JOB ADDRES�p OWNER NAMEINAMEQ INESS PLAT NAME/SUBDIVISION NO. LOT NO. L:D MAILING ADDRESS L D E $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Pennit Required C y IT ZIP TELEPHONE EXISTING.— PROPOSED Sumet Use Permit Roo Insimcdon Roquired Sidewalk Required Lm I-d- REQUIRED DEDICATION— FT Wiringroquired 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 z 5 ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAJNAGE CITY ZIP TELEPHONE A. NAME ICBL# 4,rL&&7.&gr= I -ENGINEERING REVIEWED BY OAT E Cc ATI)DRESS FIRE REVIEWED BY DATE CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE ORA B11 I INSPECTION BOND REO'D POSTED IS 13YEs 13NO SEPA REVIEW SIGN AREA HEIGHT PROPERT Y TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 74 , , EXP NEW PLUMBING/MECH RESIDENTIAL LOT COVERAGE, REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) FRONT LIRSIDE AFAR ALLOWED PROPOSED FRONT SIDE REAR COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE REMODEL MULTIFAMILY SIGN PARKING LOT AREA PLANNING REVIEWED BY DATE REQ`D PROVIDED GRADING rn FENCE REPAIR CYDS L_J X Fri REMARKS 1:1 DEMOLISH 0 TANK GARAGE IRE SPRINKLER o RETAININGWALL 0 F CARPORT ROCKERY FIRE ALARM ME OF USE. BUSM OR ACTIVITY) EXPLAIN: V CHECKER By TYfiq OF CONqTRUCTION OCCUPANT, GROUP NUMBER NUMBER OF CRITICAL OF DWELLING' AREAS SPECIAL INSPECTION JAREA OCCUPANT STORIES UNITS NUMBER REQUIRED [] YES LOAD 'DESCRIBE WORK TO BE DONE REMARKS ROGBESS INSPECTIONS PER UBC 108/FINAL INSPEC71ON REaD -T. S Ir LXCJ VALUArON �T k $ 'OF C oa Description FEE Description FEE 7v- A- (A 1� Q. -,- (o '11 Plan Chock State Surcharge HEAT SOURCE G NO % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading 2 DOMAIN (CURBS, SIDEWALKS. ORPAWAYS, MARQUEES, ETC.) WILL REQUIRE :1 SEPARATEPERM38SION. 9 Engr. Review 15 PERMIT APPLICATION:* 180 DAYS —lMrlr LIMIr I YM - PROVIDED WORK IS 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 ;APPLICANT, N 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 PERMff. ISSUANCE ORTHIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY tM ORDINANCE Landscape,frisp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PRDvISION.. Recording Fie Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPILI CATION: Tk AT THE INFORMATnJON APPLICATION APPROVAL GIVEN 18 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 pormit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Crtficlall or his/hw Deputy: and Feall are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recolpt to acknowledged In space provided. MPE N INSURANCE AND RCW 18.27. PQCIALS SIONATURE DATE OR AGENT) DATE SIGN SIGNATUR Elf WNNI ED IAIJ 15) 20- 7 2110 771 -0220 Z q, RELEAWD 6Y DVV OtENTION 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