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20030622.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING IkDDRESS j -7 S7- CITY ZIP TELEPHONE NAME ADDRESi CITY NAME ZIP ITELEPHONE ADDRESS CITY ZIP TELEPHONE CBL N [0 1 1 1 PERMIT EXPIRES US E PERMIT ZONE NUMBER �2 JOB SUITE/APT# ADDRESS /7-'5'-,OH -71YA- 4e PLAT NAME/SUBDIVISION NO. NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW PstrM Required Street Use Permit RKd EXISTING — PROPOSED Inspection Required Sld&w&lk Required REQUIRED DEDICATION— FT Underground im gr — METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO 13 z I REMARKS z OWNER/CONTRACTOR RJSPONSIBLE FOR EROSION CWROUD!rINAGE 11fe044- / R AO.'#A 1_'_:�D ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE ul cc IEL VARIANCE OR CU SHORELINEORADB# I INSPECTION STATE LICENSE NUMBER EXPIRATION DATE] —CHECKED BY REO'D SE REVIEW SIGN AREA - [3YEs I 13NO . PROPERTY TAX ACCOUNT PARCEL NO. 21 a C2 L COMPLETE EXP , EXEMPT NEW M41 RESIDENTIAL PLUMBING / MECH LOT COVERAGE ALLOWED PROPOSED ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL muLnFAmiLy SIGN PARKING REOD I PROVIDED LOT REPAIR GRADING FENCE CYOS x FT) REMARKS DEMOLISH TANK GARAGE RETAININGWALL FIRE SPRINKLER CARPORT ROOKERY FIREALARM (TYPE OF USE. BUSINESS OR ACTIV srk— CHECKEErBY TYPE OF CPO I NUMBER OF 2-- NUMBER OF DWELLING CRITICAL AREAS SPECIAL INSPECTION CRIES UNITS NUMBER JARE REQUIRED 0 Y1 DESCRIBE WORK TO BE DONE I BOND POSTED ,S (Fr.) REAR z REVIEWED BY DATE GROU OCCUPANT LOAD ,REMARKS :PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE _F­51LAZING % 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 t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading :1 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION: IGO DAYS CL PERMIT LIMM 1 YEAR - PROVIDED WORK 15 STARITIED WiFHIN 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 Plan Chk. Deposit N INTERE9T AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, ��SHINGTON, 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 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO WAIVE OR REDUCE OF ANY CITY ORDINANCE I Landscapeinsp. Total Amt. Due MODIFY ANY REQUIREMENT .0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- z ffiE — Recording Fee Receipt # I HERE13Y 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 Building Official or his/her Deputy: and Fees are 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,GOMNSATION INSURANCE AND RCW 18.27. LfS*W&G-AIGNATURE DATE SIGNATURj JOWNEA OR AGE" DATE SIGNED 11425) )0 Lz��-T 771-0220 . RELE E DATE ENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl- —JL"k 313 1 G(I/N IL YELLOW.&SPE&OIR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 Ow C - OWN GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES a EEN - ACCOUNTING ..... .... .. 4 I TE RECEIVED _PA CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEfNAME OF BUSINESS &A/ mm 0— "Ag e MAJUNG ADDRESS ST -OV F, LAJ 1-7 L�-6)Fp CITY .LEPHONE NAME AIIDRE135 CITY ZIP ONE NAME CBL 0 ADDRES3 1194 'kh,44 CITY ZIP TELEPHONE I STATE LICENSE NUMBER EXPIRATION DATE I CHECK PROPERTY TAX ACCOUNT.PARCEL NO. NEW 0 RESIDENTIAL PWMBINGIMECH 3 ADDrTION COMMERCIAL COMPLIANCE OR CHANGE OF USE 1:1 REMODEL muLnFAmiLy SIGN 1:1 REPAIR GRADING CyDS FENCE X FT) DEMOLISH 0 TANK 0 GARAGE CARPORT ri RETAININGWALL — ROCKERY FIRE SPRINKLER FIRE ALARM (TYPE OF USE, BUSINESS OR ACTI��� I NUMBER OF NUMBER OF DWELLING RITICAL AREAS I CUMBER STORIES UNITS I DESCRIBE WORK TO BE DONE ]_PERMIT EXPIRES UbE PERMIT ZONE O� ZOL -O(Z 2 NUMBER — J013 SUITE/APT# ADDRESS A-e L-j PLAT NAMEISURDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Ps=sd Street Use Parmk Req d EXISTING — PROPOSED Inspeedw Requited S1d*Wa1kRWwkW REQUIRED DEDICATION— FT Underground WWgrequired [3- METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES[3 NO 13 REMARKS OWNERICONTRACTOR RJSPONSIBLE FOR EROSION CQbVROUDTINAGE -41 Ilk-'ey /- J R .0e-4 /,Sv 1 BY FIRE REVIEWED BY DATE w AM Afle� VARIANCE OR CU EDBM 1M. I BOND �EEP"� FRO POSTED 9 IfY $ SEPA REVIEW SIGN AREA COMPLETE EXEMPT ALLOWED S ROPOSED EXP , LOT COVERAGE CKS (Fr.) ALLOWED PROPOSED 0 r IDE REAR ob 141 PARKING LOT AR =&REVIEWED BY DATE REO'D I PROVIDED M CHECKEDrBY TYPE OFPPQN,,6.TRUC-0ON CQDE_ 0GUUFANj-% �— I 1224- GR 4t.S_ i SPECIAL INSPECTION. JAREA OCCUPANT REQUIRED r-1 YES LOAD REMARKS S PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION RE0fD INS 251010 VALUAIIUN . $ I ) Dril, I Description FEE Description FEE Plan Check state Surcharge 3 M HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing A Mechanical 4 THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE On PRIVATE PROPERTY OHLX ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DMVIEWAM MARQUEES, ETC.) WILL REQUIRE SEPARATE ' PERMISSION. Engr. Review PERMIT APPLICATION: 180 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 Plan Chk. Deposit I IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Reoelpt # ALL CLAIUS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY — FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt Due DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANN ORDINANCE PROVISION.' Recording Fee_ Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORREM 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 peffnit until signed by the TION; AND IN DO4NG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO Building Official or hlaftw Deputy: and Fees are paid, and F R INSPECTION rocelpt Is acknowledged In zpace provided. WORKMER N N INSURANCE AND RCW 10.27. _00WI001-WINIATURE DATE DATE SIGNED (A9 03 SIGNATUR4 (OWNE R AGENT) x125).,---- oi- A 771-0220 ' E E DATE ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 9Fr A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- IdIll' (t��l YELLOW - &SPE&OR fAF I CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK 14 GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES EEN -ACCOUNTING SENSE z 0 0 M