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20030585.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS <:�o gx; MAILING ADDRESS (l,57-7 CITY ZIP �TELEPHONE L 12 _7_1 980 > Lj NAME ADDRESS CITY ZIP TELEPHONE IC13L N NAME C'0,ze_'( cc ADDRESS CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY NEW DENTIAL RE I KE]COSMMERCIAL PLUMBING / MECH ADDITION COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN GRADING REPAIR 0 CYDS FENCE ( _x FT) '-.*7EMOLlSH TANK OTHER GARAGE RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM OWE OF USE, UUSINESS OR ACTIVITY) EYPLAIN: '4�21'40M_BEROF NUMBER U CRITICAL M OF DWELLING R A EAS STORIES UNITS NUMBER DESCRV9jNORK TO BE DONE `4�77hL,1, Aor.- k _171 I r_> � � --T— — I A--- A A_,e- r-- if) A AA A Ira, '� "506� N"R0 HWSPrCE GLAZING % LOT SLOPE % PLM CHECK NO: VESTED DATE THIS PERMrF AUTHORIZES ONLY THE WORK NOTED. THIS PERMff COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC U DOW& (C RBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) VALL REQUIRE t SEPARATE PERMISSION. PERMrTAPPILICATION: 160DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICAP9 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 MSUANCE OF THIS PERMIT SHALL NOT BE 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. - 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�L21F THE LABOAX.GQf OF THE STATE OF WASHINGTON RELATING TO WOR3MeN%X_ ,*Ygrj�SA30KINSURMCE AND RqW 18.27. E E R AGENT) DATE SIGNED USE ZONE JOB ADDRESS6'5�;7 PERMIT EXPIRES 42r, / / z PERMIT NUMBER"-' SUITE/APT# 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 Roq'd EXISTING — PROPOSED Inspoction Required Sidewalk Roquirod REQUIRED DEDICATION— FT UndwWMM Wiring required METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED 1—';0. I YES13 NO C3 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ENGINEERING FIRE REVIEWED BY 0 z DATE Lu dc rL VARIANCE OR CU SHORELINEORADB# INSPECTION BOND REQ'D i POSTED I 13YEs 13NO S SEPA REVIEW SIGN AREA HEIGF_ COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED , I I EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR z PARKING 'VIEWED DATE REO'D I pRMinr-n I LOT Al BY - AL REMARKS CHECKED BY ITYP NSTR COOS — OCCUPANT 2,7 GROUP SPECIAL INSPECTION AREA OCCUPANT LO REQUIRED [:] YES IOAD PER USC 1108MINAL INSPECTION REG'D 099cription FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing .0- Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt N CALL FOR INSPECTION 771-0220 EXT 1333 APPLICATION APPRO' kL4 This application Is not a permit until signed by the Building Otflclal or his/her Deputy: and Foos are paid, and receipt Is acknowiodged In space provided. OqIA� MNAT DATE _fr104ED BY DATE UKil �& A A 1-01Z 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 YELLOW - INSPEiC CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 4 0 M :j :ji L . (0-4 3: M C M 0 C � x M M 10 0 _n n MM 0 0 Fn' C9 0 z W z 0 0 M W4 qo �DATE RiECEIVED / CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMENAME OF BUSINESS Co MAILING ADDRESS �57 5-F CITY ZIP TELEPHONE NAME ADDRESS CITY ZIP ITELEPHONE NAME CBLN ADDRESS &3r,3 WAwAi-k c-;T-, CITY ZIP :LEPHONE 65"T:�� VV, P, 40 Z4 I Tr 1/2!�- 77/, STATE LICENSE NUMBER NEW ESIDENTIAL PLUMBING/MECH ADDITION 1 COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE REMODEL mummmy [:] SIGN REPAIR GRADING CYDS [3 FENCE X FT) 0 DEMOLISH TANK 0 OTHER oGARAGE CARPORT RETAJNINGWALL ROCKERY F RE SPRINKLER FIRE ALARM (TYPE OF USE, 12JS1 NESS OR ACTIVITY) EXPLAIN: , 6? CRITICAL NUMBER' 7 NUMBER OF OF DWELLING 1 1 AREAS STORIES UNITS NUMBER INORK TO E DONE /VeW OL, / ULML� - jn�077 �WAMWU,-Av�amg-TAM.�-4000ML;��AA 0 iwmmll—, �_%JNWA�ykj, V�41111 A, A 10 PLAN CHECK NO: PERMIT EX IRES USE PERMIT ZONE 4?6 NUMBERr_ JOB SUITEJAPT# ADDRESS,L:1 �= PLAT NAMF/SUSDIVISION NO. LOT NO. LID NO. LID FEE S TESOP Appr— PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pwrr.0 RSWWW Sum Use Psmk RWM EXISTING — PROPOSED kWP*cd"ftqWW SW&wWkA@W1r@d B REQUIRED DEDICATION— Fr Ur4womund wimo requkw cl METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE IZAV DIDE TICOT U119T EC DATE FIRE REVIEWED BY1 :1 IfifiLlf nE I H! I',' IM: Ir VARIANCE OR CU SHORELINt DR AMR TUNPEGEWW BOND REO'D I POSTED 1E3YEs 13No Is SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR PAIK3&",* L&AIr �61LAJNING ;Ra;; DATE' REQ`D n CO I , . . m%eated CHECKED BY TYPE NSTR COW OCCUPANT e9fl-I GROUP SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [j YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION.RECtO 0 Description FEE Description FEE D 7—n escript 0 Plan Check State Surcharge Surcharge Building'Permit Cltyj Plumbing %-3VIO, Mechanical TWS PVMrF AUrNORGIES OMY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DommN (CURBS, SIDEWALKS, DRrVIEWAYS, MAMUEES, ETC.) WILL REQUIRE drading SEPARATEPEIRMISSIOIL Engr. Review PERMITAPPLICATION: 180DAYS LOT SLOPE % DATE PERMIT LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 190 DAYS Engr. Inspection SEE BACK OF PINK PEWrr FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, tIEIRS, ASSIGNS AD. SUCCESORS Fire Review Plan Chk. Deposit IN INITEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt III ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.. Recording Fee Receipt III I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION AFPPROVAL GIVEN IS CORRECM AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE To COMPLY WITH CrTY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit unIN signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATIQtLQF THE LABqAA"f OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Official or hlsftw Deputy: and Fees are paid, and receipt Is acknovAedged In space provided. Wo�� .AWINSU"CE AND RrM-27- 4#MSA 0 DATE pIGNATL6V"E0R AGENT) IDATE S GNED (425) .301 A)_z_ 771-0220 411-A)ED BY DATE AWENT15N EXT 1333 UM�)\ 1A A A 41/-, 1. L_ IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL LL�l A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES ORIGINAL -FILE YELLOW-INSPEOPt PINK -OWNER GOLD -ASSESSOR�R/ GREEN - ACCOUNTING cm