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20030575.pdfDATE RECEIV4,,// tl � CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION ER NAME/NAME OF BUSINESS VIC-/4111614f &VU11'444 I J.'MV& T%VAA1e_S MAILING _Ae t CITY Ej NAME ADDRESS CITY NAME aklE�__ ADDRESS CITY STATE LICENSE NUMBER I & I ZIP TELEPHONE FA 71 ('11 1 Afa. ZIP ZIP I TELEPHONE J/9 CBL N [PERMIT EXPIRES ZONE USE PERMIT 4,,., 7 NUMBER __e6 ADD F1,111 UITEJAFT RESS C) I 6x_ ��IS .:w !z— PLAT NAMEISUBDIVISION NO. 0. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCIR AP Rw Ponnit"I".1%ed Straet Use Permit Raqd EXISTING — PROPOSED InspwWriRequited C1 SkierwalkRequira,d 13 REQUIRED DEDICATION— FT UnderWound Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES C3 NO C3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE REVIEWED BY DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE OR ADB# I INSPECTION BOND CHECKED BY 1[3 REQ YES LD / I POSTED )to 1$ SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED . PROPOiSED rALLOWED . PROPOSED VO-w RESIDENTIAL PLUMBING/MECH 0 ADDITION COMPLIANCE OR IPCOMMERCiAL CHANGEOFUSE REMODEL MUL11FAMILY KrSIGN REPAIR 0 GRADING CYDS o FENCE X ( _ FT) DEMOLISH TANK 0 OTHER -1 GARAGE 01 RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM I(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: W1 t* pil NUMBER OF NUMBER OF DWELLING I CRITICAL AREAS STORIES UNITS NUMBER JV& DESCRIBE WORK TO BE DONE W LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FR04ff__jJB.SlJI2E__BW I I — z PARKING LOT AREA jyNNrG REVIEWED BY DAIA7 CL REQ`D I PROVIDED In CHECKED 13Y jTYPEMrTR OCCUPANT CN I GROUP SPECIAL INSPECTIOINI—rRE OCCUPANT REQUIRED [] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REO'D 2 HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC DOMAIN (CURRS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERUrTAPPILICATION: 180 DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMrT FOR MORE INFORMATION 'APPLICAK 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 REQUIREME14T OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITTS 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 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMENS COMPENSAT ,JON-W5,U,,RANCE AND RCW 18.27. SIGNATURE (OWNER UAGE" DATE SIGNED -71J4 15)% A.A AJAIJI A. I $ Description FEE Description FEE Plan Check state Surcharge Building Permit ity Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION (425) 771-0220 EXT 13133 APPLICATION APPROVAL This application is not a permit until signed by the Building Omcial or his/her Deputy: and Foes are paid, and receipt Is acknowledged In space provided. OF ALS S ZTURE D�T E �// FPS E D VBY R /; 2 / .. 1 V 1A I I A' q11 JA 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. INSfECTC CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING k .. z 0 M M -18 0 C: 3� C M M ,C) i C 2 M 8 0111 Fn M 0 W z 0 0 M a OML Fn, f CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS -rrqr.,/.d(V&j- MAILING kDRESS .Ao k 57 H Ave, S.- �A;k I CITY ZIP TELEPHONE Ejynojjc� NAME ADDRESS CITY ZIP TELEPHONE .-Y —'rCBL N NAME ADDRESS CITY ZIP I TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY PLUMBING/MECH 0 ADDITION COMMERCIAL COMPLIANCE OR 1:1 CHANGE OF USE REMODEL MULTIFAMILY E311SIGN REPAIR 0 GRADING CYDS Ei FENCE X FT) 0 - DEMOLISH TANK OTHER c3GARAGE [3 RETAJNING WALL FIRE SPRINKLER CARP FIT ROCKERY� FIRE ALARM (TYPE OF USE, BUSINESSOR ACTWM ERPIAIN: I 7 R&A %yv- 4 01A fnilliwn Mgll NUMBER OF NUMBER OF DWELLING 0 10 1 CRITICAL AREAS STORIES UNITS NUMBER dVl*& DESCRIBE WORK TO BE DONE MWILONEAMIC, GAWT-�- EXPIRES OSE ZONE PERMIT C-, 75- NUMBER4V_� -e6 JOB ADDRESS 901 G11- 61e, ulw#;7 3� PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP AP=9d Aw pefMM EXISTING — PROPOSED stmet Use Peffnit R80 inspection Ftoqt*W SidmalkRoWired REQUIRED DEDICATION— FT Undwi;r-rd LOW METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 1 1 YESE3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLARAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE 1 11 VARIANCE OR CU SHORELINEORADBN I INSPECTION BOND PT REq'D / 113YES %0 POSTED 1$ SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWEDI PRI POI 1 HEIGHT ALLOWED PRO BED EXP X_ k, %- M I LOT COVERAGE REQUIRED SETBACKS (FIL) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FROUTjAAlA6.MM PARKING REO'D I PROVIDED LOT AREA I P�ANNIVG REVIEWED BY DATE— 11 1 1 )) v-,-:) � -- CHECKED BY ITYPE =LICIT110N n f'UPANT V IMP— - GROUP SPECIAL INSPECTION JAREA OCCUPANT REQUIRED LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0 q±h2C&d &Sj�af&LfAl "5,_rzW�ef VALUATION VVIVIN 111111111111110 1 now $ 1 Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMff AU"MUMS OWJY THE WORK M)TED. THIS PERMIT COVERS WORK TO 1: BE DONE ON PRIVATE PROPEFM ONLX ANY CONSTRUCTION ON THE PUBLIC X DONLAUJI (CURBS, Sloliiji��. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRIJ Grading WARATE PERMISSION. Engr. Review PERMrr APPLICATION: 111M DAYS PERMIT LIHM 1 YEAR - PROVIDED WORK IS STAMMO WITHIN 160 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT ON BEHALF OF NO 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 CLAIUS 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 Landscapeinsp. Total Amt. Due 21 NOR LIMIT IN ANY WAY THE CITYS 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 DCING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO Building Officiall or hisfher Deputy: and Fees arc paid, and FOR INSPECTION receipt Is acknowledged in space provided. WORKMEN$ COMPENSAT D RCW 18.27. S S19NAT O�FF URE D4trE SIGNATURE (OWNER AGENT) DATE SIGN71) (425) I 771-0220 �SED B . ®R ATTEM10—N EXT 1333 b, A IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ,/ 1,4111 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLCIN INSf6TOR 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 _j z 0 4 0 ITI M C rn -48 0 C: 5� z A T 10-4 0 _n M M Fit C A o z z 0 i 0 rn