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20030659.pdf0 DATE RECEIVED PERMIT E)(PIRES CITY OF EDMONDS USE PERMIT ZONE " NUMBER i� CONSTRUCTION PERMIT APPLICATION JOB ADDRESS OWNER OF BUSINESS ,kAMEINAME v<woy go: k; PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 15 MAILING ADDRESS 21 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP LID FEE $ TESCP Approved RW Perffgl Requirsm CITY ZIP TELEPHONE EXISTING - PROPOSED Street Use Permh neq'd Inspection Required 93 Sidewalk nequired Sf 22�Li2a� 251-mka- REQUIRED DEDICATION- FT Ur4artiround Yfiringfequired 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO 13 ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE 411L, W��,)(J CITY ZIP =ONE t1foA 0 M-If 0C NAME CBL# 0 VL6 la Cjli,111112hl�)l E ERING REVIEWED BY DAZE _')AArX ADDRESS 37 �Jit C21 L6ua, i_k/o BY DATE FIRE REVIEWED us lmr CITY ZIP TELEPHONE STATE LICENSE NUMBER NEW RESIDENTIAL ADDITION r COMMERCIAL 0 REMODEL MUL11FAMILY [:] REPAIR GRADING CYDS DEMOLISH [3 TANK GARAGE CARPORT [i RETAININGWALL ROCKERY (TYPE OF USE. BUSINESS ORtQTIVVMAXPLAIN: NUMBER NUMBER OF OF DWELLING STORIES UNITS I DESCRIBE WORK TO BE DONE I CHECKED BY VARIANCE OR CU SHORELINE OR ADBN I INSPECTION I BOND REO'D POSTED E3YEs 13NO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED , PROPOS ED ALLOWED I PROPOSED :XP LOT COVERAUC REQUIRED SEIHAGKS � F PROPOSED Sal 0 PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIKIREA'R COMPLIANCE OR 1:1 CHANGE OF USE PARKING LOT AREA I PLANNING REVIEWED 13Y DATE [:1 SIGN REQ`D I PROVIDED FE I I REMARKS ( !2L x so FT) i OTHER F RE SPRINKLER FIRE ALARM CHECKED BY TYPE PFQONS UCT ON OCCUPANT e) I P ` GROUP CR11ICA . L I . AREAS SPECIAL INSPECTION g WIREMARKS OCCUPANT NUMBER REQUIRED 0 YEs _JAREA LOAD PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG'D, VALUATION $ 1 Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % I Building Permit City Surcharge PLAN CHECK NO: VESTED DATE 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 Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180DAYS PERMIT UMM I YEAR - PROVIDED WORK 15 STAMED WITHIN 160 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 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. 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 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- CALL TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION 9F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION WORKMEN'S 9D�PkNSATION INSURANCE AND RCW 10.27. 81?NYURLEWNE 0 P)AGENT) DATE SIGNED (4-25) WERNTION 771-0220 TIO EXT 1333 Plan Chk. Deposit Receipt # Total Amt. Due Receipt # APPLICATION APPROVAL As applicatlgQ Is not a permit until signed by the rl"fiiclaltr ,119/hor Deputy: and Fees are paid, and rotal h � nowledgodlp space prqded. ki-SISIGNUORIS 11, - %, / I DATE IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 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 E RI&N FILE YELLOVANSPECT/C PINK - C�W. GOLD - ASSESSOR GREEN - ACCOUNTING z 0 :1 0 m FINAL PROJECT APPROVAL FORM TO: z 9 0 m =, 9 us ---r' 0 rn c m 0 80 c 3: rn M Z 0-4 c cn 0 -n n m M 0 0 0 M C ca c cn M 0 z M z --q 3: cn z 9 0 m 2. 3. RE_jNSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Si omprvl.doc.l:temp:bldg:formsIO/OI "'.INSULATION. ................... Floor Insulation ......... Well Insulation ... Ceiling Insulation SHEETROCK NAILING ... Yi SPECIAL INSPECTION f, MISCELLANEOUS .......... Fj AnnMOMOAN Cf%D rk A I 'Ir 4 f E RECEIVED z 18Y. , ��ATE Ass, PERMIT EXPIRES 3--11 ININ101 —C P r 7 USE ZONE ERMIT CITY OF EDMONDS P\ _\ ki"ammon �_av CONSTRUCTION PERMIT APPLICATION 1WNER_&kMEffiIME OF BUSINESS CITY NAME ADDRESS CITY NAME ADDRESS CITY ..STATE LICENSE NUMBER 11,P= Ou PT MIS, '21 ZIP ITELEPH( ZIP ITELEPHONE ZIP I TELEPHONE EXPIRATION DATE I CHECKED 13Y JOB 5-F AUFTE/AFT# ADDRESS qjD I I PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S YES PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP W -,=. Sow Use PafmN RWd EXISTING - PROPOSED kwp"rdon ReqLAW awswast Rewkw REQUIRED DEDICATION FT Ur4wWound WIMg requ4id I METER SIZE LINE SIii NO. OF FIXTURES PRV REQUIRED YES[3 NO 13 REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLMRAINAGE PAI I -Rv, -F-thkt, 1A) Qhr�n a fi '0 A 0 IWI gn PKI r-)P R;M d;G_ I-OUL6 Xis REVIEWED BY xp-6(vaa: �f 1,0 0 FIRE REVIEWED BY DATE VARIANCE OR Cu SHORELINEORADE14 I INSPECTION BOND REOD POSTED 13YEs ONO SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED :xP 0 NEW ADDITION RESIDENTIAL �5 COMMERCIAL 1:1 PLUMBING / MECH COMPLIANCE OR CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR REMODEL [3 REPAIR MULTIFAMILY 0 GRADING CYDS SIGN FENT I I it X -50, FT) PARKING REO`D REMARKS LOT AREA PLANNING REVIEWED BY DATE DEIWLISH TANK OTHER o GARAGE CARPORT o RETAINING WALL ROCKERY OWE OF USE, BUSINESS OR LAIN: o FIRE SPRINKLER FIRE ALARM CHECKED BY TYPE r N OCCUPANT V1 -I ,ONST GROUP NUMBER NUMBER OF CRITICA U& 0 OF WELLING RIES UNITS DESCRIBE WORK TO BE DONE An EAS 40-- NUMBER S :CIALINSPECTION RPE%69ED r] YES AREA OCCUPANT LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD Zg214 6617 --- VALUAPON n L walmlir 66 1 &W Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % �uildlng Permit lCitySurcharge 1 PLAN CHECK NO: 03 - L? VESTED DATE PlUmbing THIS PERMIITAUTNORME O"W THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical BE DOME ON PRIVATE FR OPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURSS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) VALL REQUIRE Grading SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION: 11110DAYS PERMIT LIMIr I YEAR - PROVIDED WORK 18 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 '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, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY I 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 Landscapolnsp. Total Amt. Due Non 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 COMPtY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL This app4!c�t1oq Is not a pannit unfil sIgned by the , , TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED' B�&g sftw Deputy; and Fees are paid, and =11plooModgedl9spacopt IN VIOLATION PFTHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION tl?,r ad. ::v WORKMERS "P�NSATION INSURANCE AND RCW 18.27. OF QIALSAIGNA�U(49 _QIDATE 7 T STRE VER ;0;GENT) DATE SIGNED t4-25) LEASE771-0220 AftENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD;,Y.QU ARE MAKING 5 COPIES RIGIN14�F I Ell OW I INSPECTOR C. C_ Y PINK - . ? PIR f-0LD-ASSESSOR GREEN - ACCOUNTING 1 . t z 0 0 IT11 ITI MS -10 0 M M 0 In .1n M M Fn 0 z z 0 0 M