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20030584.pdf4 cm� I DATE RECEIVED FCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION I0W_NFMqNMA1MEfNfME OF BUSIJESS I I I I MAILING A*RESS 1 7 23 0 AF/z *5_/ 5�1 " /M ZIP TELEPHONE Mfif"Izell-5 lmy 1 yp_-5 .6 YO _;1 NAME ADDRESS CITY NAME cc ADDR, SS CITY STATE LICENSE NUMBER ZIP ITELEPHONE ZIP I TELEPHONE PROPERTY TAX ACCOUN7r PARCEL NO. QQ �'Q6 - 20 id /10 [:] NEW 000'RESIDENTIAL 13 ADDITION [:] COMMERCIAL 13 REMODEL QI<ULTIFAMILY [3 REPAIR GRADING CYDS 1:1 DEMOLISH TANK 1 GARAGE :1 CARPORT RE7AININGWALL ROCKERY OWE OF USE, BUSINES EXPLAIN: 8MM(T NUMBER OF NUMBER OF DWELLING I I i STORIES UNITS DESCRIBE WORK TO BE DONE CBL # FPERMIT EXPIRES Q!A ZONE PERMIT -3 NUMBER —0594 JOB UITE/AP`T# ADDRESS 7 -7�� 16T �2 b -<-LJ- PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCIP Approved RW permit Required Street Use Permit ReWd EXISTING — PROPOSED Inspection Required 13 Sidewalk Required 13 REQUIRED DEDICATION— FT UndeWound - —'Y' uIred 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YEs[3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE REVIEWED BY DATE FIRE REVIEWED BY DATE I MUM" OR C SHORELINE OR ADB# INSPECTION BOND DATE CHECKED BY REO'D POSTED SEW REVIEW t SIGN AREA 113YES ONO I $ HEIGHT COMPLETE . EXEMPT I ALLOWED , PROPOSED I ALLOWED , PROPOSED 9!rPLUMBINGIMECH COMPLIANCE OR CHANGE OF USE SIGN FENCE ( X FT) OTHER 3 FIRE SPRINKLER FIREALARM CRITICAL AREAS NUMBER LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR PARKING LOT AREA I PLANNING REVIEWED BY DATE REDID I PROVIDED I r7o� CHECKE61PYCON Caw� OCCUPANT Tu GROUP I P_ SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [3 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ*0 $ L Aaelt"I411— lZe Description FEE Description De"C"P"o FEE 9 C/ Plan C heck SUrc State Surcharge HEAT SOURCE ALAZINGAA LOT SLOPEN Building Permit UrCha City Surcharge ity S rg PUN CHECK NO: VESTED DATE Plumbing Mechanical Ftatehar THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO It BE DONE ON PRIVATE PROPEFITY ONLY. My CONSTRUCTION ON THE PUBLIC Grading a -6, ETC.) WILL REQUIRE DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEE SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION: ISO DAYS PERMIT LIMM 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 PI." pi, 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 NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt # FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE N DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due Aj k 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 appilcation is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid. and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknovAedged In space provided. WORKMENS P N INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE SIGNATU GENT) DATE SI (425) _T & 1*21 ) 771-0220 f , _79EASEU7i T10pr �,T�lSr_LOAWFUL EXT 1333 /0 TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN F - YELLOW * IN 4PECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK- NrR GOLD -ASSESSOR 04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING il RECORD OF INSPECTIONS fo DATE RECEIVED 'A A CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWN NAME7ME OF BUSINESS MAILING RESS !��, �0� 7 2 �z 11h ZIP TELEPHONE zllomtI5 Aly 1 NAME ADDRESS CITY ZIP SE PERMIT ZONE NUMBER 0 JOB SUITEIAPT# —7 -7,3�2 ADDRESS j6Tb_t'A PLAT NAME/SUBDIVISION NO. FLOT NO, LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESGP Approved RW Penra Raqjkw Street Use pann RoWd EXISTING — PROPOSED lnspwdw Wulred Sidewalk flaquired REQUIRED DEDICATION— FT UndorWmM WWC recitAred 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES0 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE NAME,� CBLN ff-ENGINEERING REVIEWED BY DATE CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE PROPERTY TAX ACCOUNT PARCEL NO. 2 20 A) /10 It 0 NEW p [ffo'RESIDENTIAL 1:3 ADDITION [:] COMMERCIAL 11 REMODEL D34ULTIFAMILY [:] REPAIR [:] GRADING CYDS 0 DEMOLISH 0 TANK EiGARAGE RETAININGWALL CAR ORT ROCKERY LAIN: (TYPE OF USE, BUSINESSP(T NUMBER OF 'T4UMBER OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE FIRE REVIEWED BY DATE — VAR C r IANCE OR CU SHORELINE OR ADB# I INSPECTION PBOND HECKED BY RE OSTED OYES SEPA REVIEW SIGN AREA HEIGHT I COMPLETE . EXEMPT i ALLOWED . PROPOSED I ALLOWED , PROPOSED us rL LOT COVERAGE REQUIRED SETBACKS (Fr.) I PROPOSED SETBACKS (Fr.) ErPLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR LIR SIDE REAR COMPLIANCE OR CHANGE OF USE ___rNT PARKING LOT AREA PLANNING REVIEWED BY DATE SIGN REQ`D PROVIDED I I oFENCE ( FT) REMARKS OTHER -0 twe IA,* 0, FIRE SPRINKLER FIRE ALARM he Z�x CHECKED BY CO 06CUPAIIT 1py GROUP �c T—CRITICAL AREAS NN SPECIAL INSPECTION AREA OCCUPANT NUMBER REQUIRED [:] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC loa/FINAL INSPECTION REGID MMM=k RMWM,,M ./jW""AFf MQ HEAT SOURCE' GLAZING0% LOT SLOPEr% PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRTVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION. 180 DAYS PERMIT LIMM I YEAR - PROVIDED WORK 13 STARTED WTTHIN 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 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 NOR LIMIT IN ANY WAY THE CffY8 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 VIOLATIO;NOHIE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO P WORKMEN P SATqDN INSURANCE AND RCW 18.27. SIGN7ATU �rGENT) DATE SIGNO I k $ ----I Description FEE Description Deacirlpt'O' FEE Plan Check S t, Surchar State Surcharge Building Permit City Surcharg City Surcharge Plumbing Mechanical Fta Grading Engr. Review Engr. Inspection elk Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION 1A10 1,425) 771-0220 APPLICATION APPROVAL This application Is not a permit until signed by the Building Official or hiaftr Deputy: and Res are paid, and, recelpt to acknaMedged In space provIdad. OFFICIALS SIGNATURE D�TE 6)C3 'IfELEASE I D 'T ATTq#TIO Off 1333 IT IS UNLAW2 rTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL /_0 A FINAL INSPECTIO14 HAS BEEN �ADE AND APPROVAL OR A CERTIFI- OR�GINA� VF YELLOW - INdPECTOR E, CATE OF OCCUPANCY HAS BEEN RANTED. UBC SECTION 109 PNK- ER GOLD.ASSESSOR 04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTiNG z 0 4 0 ITI M M Or M 10 O"n MITI 0 C C CO) 0 z 0 4 0 ITI