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20030639.pdfI DATE RECEIVED CITY OF EDMONDS i64 JOB CONSTRUCTION PERMIT APPLICATION ADDRESS kFjj"EWME OF BUSINESS I I— I I MAILING ADDRESS _j t+q66 TeAo& Road CITY ZIP I TELEPHONE f�tma,J,S '7 870 2- 6 1(4Z5;) 71q -- z50 2-6 NAME ADDRESS CITY ZIP I TELEPHONE NAME ICBL# ADDRESS CITY ZIP I TELEPHONE 4 PERMIT EXPIRES _424 PERMIT Z003 NUMBER h � I SUITE/APT# PLAT NAME/SUBDIVISION NO. LOT NO. L�D NO. L D FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Permit Required Street UNG Permit Req'd EXISTING __ PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES NO REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE ENGINEERING REVIEWED BY FIRE REVIEWED BY DATE DATE z STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# I INSPECTION I BOND REO'D POSTED I CIYEs 13NO $ PROPERTY TAX ACCOUNTIPARCELNO. SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 0 0 EXP , , I NEW RESIDENTIAL 13 ADDITION COMMERCIAL PLUMBING/MECH COMPL ANCE OR CHANGE A OF USE LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR REMODEL MULTIFAMILY SIGN PARKING LOTAREA PLANNING REVIEWED. By DATE REOD PROVIDED I I IL REPAIR [3 GRADING FENCE CYDS X FT) - REMARKS rl DEMOLISH TANK OTHER GARAGE RETAININGWALL FIRE SPRINKLER CARPORT 1:1 ROCKERY OFIRE ALARM (ME OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE O=N OCCUPANT 1-9—e GROUP I P NUMBER ^UMBER OF F DWELLING c ' tTICAL TAREAS )VA L SPECIALINSPECTION OCCUPANT STORIES UNITS DESCRIBE WORK TO BE DONE NUMBER UMBI JAREA REQUIRED [:] YEs LOAD REMARKS Lzm\_r exWlaj- wall -M ftwicjd Nwjv PHU RESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D A.1 4.11 CIP MW.(Al_ �6c ma-cs_ ALW'�, $ 0ox r— Description FEE Description FEE Cz rA p6o.�) Plan Check State Surcharge HEAT SOURCE GLAZING% 111T.1L aag MQSi& Building Permit City Surcharge PLAN CHECKmO- VESTED DATE 7 :��_ Plumbing __ - - Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC -WAYS. Grading 3 DOMAIN (CURSS, SIDEWALKS, DRIVE MARQUEES, ETC.) WILL REQUIRE 1: SEPARATE PERMISSION. Engr. Review PERMrr APPLICATION: 180 DAYS CL PERMIT UHrr I YEAR - PROVIDED WORK IS STARTED WnHIN 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 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. A14D AGENTS FROM ANY AND Fire Inspection Receipt III ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, 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 Landscapelnsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - Recording Fee Receipt III 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 untill 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 acknovirlodited In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OF DATE SIGNA WNkB R AGENT) DIE S GNED 1A 125) WLM�. 63 771 -0220 RELE JATE ENTION IN' Off 1333 03 NWFUL 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 z 0 1 0 M I DATE 9EcEIVED IATE XPIRES all _71�Tv�t')F EDMm ONDS PERMIT NUMBER CONSTRUCTION PERMIT APPLICATION JOB -8 ITEIAPT# ADDRESS 9 0 E OF BUSINESS 1/1 PLAT NAME/SUBDIVIS16N NO. LOT NO. LID NO. MAILING ADDRESS LID FEE S A -17(166 1�i6d- R0061 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Appm"d RW Pem* Rewsrod CITY ZIP ITELEPHONE StnW Uss Parmit PAO EXISTING - PROPOSED Inamcdo FaqWred 61dowl2na"Wed An��J$ 2- 6 r0f) REQUIRED DEDICATION- FT I UWWWaund NAME METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED' YES13 NO ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE CITY ZIP TELEPHONE NAME CBLN di Eon left A ENGIVI DATE IX 0 ADDRESS / 1 CH 111 I '^I . A . - 7 -r -- , . L,&d&&A=re /J�/ I /I - FIRE REVIEWED BY DATE I CITY ZIP TELEPHONE M I VARIANCEORCUI SHORELINEORADB# INSPECTION BOND.-_". STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY j REO'D POSTED OyEs ONO s SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 00 11:1920 f Z 0 2- EXP , , I [3 NEW RESIDENTIAL PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR ADDITION 0 COMMERCIAL COMPLIANCE OR CHANGE OF USE PARKING��EA PLANNING REVIEWED BY DATE REMODEL muLnFAmiLy SIGN RECID I PR GRADING REPAIR CYDS 0 FENCE X ( Fr) REMARKS DEMOLISH TANK OTHER [i GARAGE 0 RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM OWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE 0 N OCCUPANT to-45i aeAIJ. QJ GROUP NUMBER JAUMBER OF OF DWELLING CNITICAL AREAS SPECIAL INSPECTION OCCUPANT LOAD STORIES UNITS NUMBER REQUIRED [] YES JAREA JRECrD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC I 08/FINAL INS PECTION wm\ r PAe-A of' (-,;d I I ek fra, mcde- I N W i 1111 e Load-AtyeNm. AeA—.# C4,q I I at My-P40L94 In lz=� Uh 1. f AN&S'Ar VALUATION $ %-,;, 11:) Description FEE Description FEE -I-SR ce" hct�7t) Plan Check State Surcharge HEAT SOURCE oO' GLAZING% 1.0�`r SLOP % N" Get I extej Building Permit City Surcharge PLAN CHEC"O* VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13UC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION. 190DAYS PERMIT L1MrP I YEAR - PROVIDED WORK 19 STARTED WITHIN 150 DAYS Engr. Inspection SEE BACK OF PINK PERMFT FOR MORE INFORUATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORW. . Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CRY 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 ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due 674 NOR LIMIT IN ANY WAY THE CrrfS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # �zleqe:z-_, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPMATION APPROVAL GIVEN IS CORRECII 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 &WIcallon Is not a peffrdt untH signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WI"E EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON 'R LATING TO Building FOR INSPECTION Official or his/her Deputy: and Fees we paid, and receipt lu acknowiedged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OF I DATE SIG=R AGENT) DATE SIGNEO, &NAT. e I 6 ij 771-0220 R YATE OtENTION I _: Off 1333 05 —1 IVIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAI. - 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 W. z 2 0 M Q M M 34 C M ID 0 _n M M rn, z 0 IT11