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20030662.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION 1154 NAME/NAME OF.BUSINESS MAILING ADDRES Olew, '0 Ig CITY 0_99�1 NAME ADDRESS CITY NAME 0V D A91 ZIP ITELEPHONE �01 A A. tip ONE ICBLN . -1--A /, CITY Jill ZIP i T9LEPHONE 7. pq 5ecvTl L, ilz� �;- W —b-4— () 4 q 7 STAU IJCENSE NUMBER EXPIRATION E E Y V,144faV F-1 Imfo I QK PROPERTY TAX ACCOUNT PARCELNO. NEW __d PLUMBING/MECH RESIDENTIAL 0 ADDITION COMPLIANCE OR COMMERCIAL CHANGE OF USE 13 REMODEL MULTIFAMILY SIGN 1:1 REPAIR F NCE 0 GRADING CYDS ( E X FT) 0 DEMOLISH TANK OTHER oGARAGE CARPORT RETAININGWALL ROCKERY FIRE SPRINKLER FIRE ALARM (TYPE OF QSE, BUSINESS OR A EIT_IAN: r &1A2.0 ;IL 7�0 (T � Ir C�WC NUMBER OF CRITICAL OF I DWELLING I AREAS UNITS NUM ER .STORIES - DESCRIBE WORK TO BE DONE dq rapo dxTbi 04 PlAf4f elM HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: j VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTrUCTION ON THE PUBLIC DOMAIN (CURSS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 160 DAYS PERMIT ILIMM I YEAR - PROVIDED WORK 16 STARTED WITHIN 1110 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 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 NOR LIMIT IN ANY WAY THE CITY$ 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- TK)N; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO nRICUFhW§4MMPENSATIOW4NSURANCE AND RCW 18.27. PERMIT EXPIRES onomm� USE PPERMIT ZONE NUMBER JOB SUITEIAPT# ADDRES 65:" 222L 0 0001112&Z MY: PLAT NAME/SUBDIVISION NO. OT NO, F—L LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TIESCP Approved RW PornM Requited Street Use Permh Reld EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground Wiring required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES [3 NO 13 REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE —41 r ENGINEERING REVIEWEDBY -—I - t�fvl %f v f-11,-, FIRE REVIEWED BY DATE W VARIANCE OR CU SHORELINE OR ADBI1 INSPECTIOIN I '0 D REO'D I P'OSNTED 13YEs ONO $ SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED EIGHT AL LOWED I PROPOSED EXP I I - ____ __ LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR PARKING I LOT AREA I PLANNING REVIEWED BY DATE REO'D I PROVIDED BY - [TYPE OF CHECKED -CONSTRUCTION CODE OCCUPANT -7;TjV1_'_' q:2 . GROUP /,/-I— SPECIAL INSPECT107RE OCCUPAN-r REQUIRED (3 YES LOAD REMARKS 2 PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD., � $ L Description FEE Description FE Plan Check State Surcharge FFEE Building Permit City Surcharge Plumbing 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 IA03 %425) 771-0220 APPLICATION APPROVAL A A N T'� p This application is not a permit until signed by the T his applIcat !on 'a no a or� Building Olficial or histher Deputy: and Fees are paid, and i I receipt Is acknowledged In space provided. a Wi 4PPU D IALS S11 URE TE L S Fie -7h r REL A ED 8 ATTENTION =A 1 1 013 IT IS UNLAWFUL 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 I Z, 0 4 0 M M M 0 -40 0 C .� E : M M Z 0 M M C x M 0 z z 0 1 0 M FINAL PROJECT APPROVAL FORM TO: z 9 0 m =i 9 am c ma 0 80 c M M Z 10-1 0 -n m m 065 0 o Fn co c CD M 0 Z M --I z z 9 0 m RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL Date Sign_ ocaprvl.doc.l:t=V:bldg:formsIO/OI I DATE PATE RECEIVED,,� EXPIRES CITY OF EDMONDS USE PERMIT 7- ZONE NUMBER CONSTRUCTION PERMIT APPLICATION ON JOB SUIMAPTO ADDRES �q;Z2 NAME/NAME OFP �USINEI!S , PLAT NAME/SUBDMSION NO. LOT NO. LID NO. —ma/i MAILING ADDRESS LID FEE S TESCP ApproM 1 /?;� lojifS7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Pamilk Required __C2 CITY ZIP TELEPHO NE Street Use Peank R*q`d EXISTING — PROPOSED Inspecd- Required Wow&* Required REQUIRED DEDICATION— FT UndKWOMW WWg required NAME METER 817E LINE SIZE OF FIXTURES PRV REQUIRED 1 7. YES 13 NO 13 ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE CITY PHONE FIRE M PIAE MUST BE NAME CBLN PRESENT FOM 'TANK Ell I RE VAL, ()Wp ENGINEERING REVIEWED BY ADDRE &x _20. FIRE REVIEWED BY DATE CITY t�? ZIP TTELEPHONE 701 If VARIANCE OR Cu SHORELINE OR ADB# INSPECTION BOND STM CENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D POSTED I A �;�_Fkxacldrfp#?14 13YEs 13NO $ PROPERTY TAX ACCO P NO. SEPA REVIEW ' SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I , LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) NEW RESIDENTIAL PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR COMPLIANCE OR 13 ADDITION COMMERCIAL CHANGE OF USE REMODEL 13 MULTIFAMILY SIGN PARKING LOT AREA PLWANNING REVIEWED BY DATE RE0113 I PROVIDED 1 IL REPAIR [3 GRADING FENCE CYD S ( X FT) REMARKS OTHER [3 DEMOLISH TANK 13 GARAGE [3 RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM 17YPE OFQSE. BUSINESS OR ACTPT" EXPLAIN: CHECKED BY 0 NSTRU9Tj0N COUk_ OCCUPANT �, —Z 19 _ 'I ITYPE C40F GROUP ze NXIBER NUMBER OF RITICAL OF DWELLING AREAS SPECIAL INSPECTION' I ARIkA OCCUPANIF STORIES UNITS MBER REQUIRED 0 YES 1, LOAD DESCRIBE WORK TO BE DONE .-% REMARKS rune dwTtj,,,u4 Rilvsf PROGRESS INSPECTIONS PER UBC IOB/FIW.L INSPECTION RE= elu At. C W dT- P Leg alid f -; Me 1- 2, s VALUIAn0N C $ 6MAPE Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PMVATIE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WItL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS PERMIT L11MIr I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. 1pspection 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 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMTE 18SUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt�.D. Lie DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITTS 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 CONS'MUC- This appikation Is not a pannit until signed by the CALL TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Otklal or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMWVCWPENSA��SURANCE AND RCW 18.27. IALS 81 URE QAATT E �(OWN R DATE SPNED 1A9 %7ff-5 A A, /, 1, A 1 WA6 771-0220 REL 13 OF ED a ATTENTION EXT 1333 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 - 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 =j 0 1711