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20030663.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS _Uc?.75— AMPIEWZ) 4vF_ ZA CITY ZIP TELEPHONE 7, NAME ADDRESS CITY I / r flp / /P X, I I PERMIT EXPIRES USE PERMIT 1 ZONE NUMBER.�Z72_ JOB 1104 ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE' Wlc.F,.4'.P,'=. Street Use Peffnft Req'd EXISTING - PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION- FT Underground Wirtrigrequired 13 METER SI ZE LINE SIZ OF FIXTURES PRV REQUIRED 13 YESM NO 13 ?5 REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I Ir 0 NAME F S f 1co RESS;Qj� 6ox3IRROC" CITY ZIP A ZE qjL6131 5�5 7T_ STATE LICENSE NUMBER RtCoc ino PROPERTY TAX ACC9qPj1E&, CBL# TELEPHONE dod-sq7 9114. EXPIVTION DATE By ENGINEERING REVIEWED FIRE REVIEWED BY VARIANCEORCU SEPA REVIEW COMPLETE EMPT EX BY DATE DATE SHORELINE OR ADBN INSPECTION BOND REO'D POSTED SIGN AREA E3YEs ONO $ HEIGHT ___ A�jft Al"M ALLOWED PROPOSED I 14 . VI; LU me M ;�j 70C2 &" l5q; F_ N FOR , EXP iLAi 6-t tit: r- ERE ; NEW RESIDENTIAL 13 PLUMBING MECH LOT COVERAGE *)TBACKS (FT) ALLOWED PR6jW?* tM SIDE REAR ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN PARKING REOD I PROVIDED LOT AREA PLANNING REVIEWED BY DATE REPAIR GRADING CYDS FENCE X FT) REMARKS DEMOLISH TANK OTHER GARAGE [3 RETAINING WALL 0 FIRE SPRINKLER FIRE ALARM CARPORT ROCKERY (ME OF USE, BUSINESS OR A 01( jo�e�C M �,% j V I Z4ff IN: '01 CHECKED 13Y "a"a" JTY1?&7=rN OCCU�ANT;�.qj GROU NUMBER NUMBER OF OF DWELLING CRITICAL A SPECIAL INSPECTION OCCUPANT STORIES UNITS N JAREA REQUIRED 0 YES LOAD DESCRIBE WORK TO BE DONE 00c: eaT e?M(7ftrT_f'5; RW�=,) REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D 1 19 11 11 VALUATION Description FEE Description FEE Plan Check I State Surcharge HEAT SOURCE 761LAZING % 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 32 DOMAIN (CUR13S, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPUCATION: 160 DAYS PERMIT UMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 150 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. 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 HE Landscapelnsp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CaYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - Recording Fee Receipt # I HERESY 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 unill signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building official or his/her Deputy: and Fees are paid, and receipt Is acknowledged In space provided. WORKMEN'S MPEN No RCW 18.27. OEEIGIAL SIGNiATURE DAJE S NE 0 A ENT) 1 DATE Spbft 0425) 9V 2 714 771-0220 -FIELEASED'61'-- 'DATE f ATTENTION EXr 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 NINE z 0 M M C M§ 0 a M M z 0 _n _n M M Fn am ic CO) M 0 z 0 0 M z 0 1 0 m :q 9 M c M 0 a -10 c jK X M m 93 Z 0 -n n Fn m 0 7m 0 f- 0 M C co) M co) M 0 Z M z z 9 0 m 2. 3. S GRANT FINAL PROJECT APPROVAL OUTSTANDING ISSUE Si ocaprvl.doc.l:temp:bldg:fonnsIO/OI t I Wr I . ?) - , ; I., . . I �k 4r, 7k�4*� %�i." I fo tr6l' RECORD OF INSPECTIONS tl . L 0 c 01. ol m I RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS __UA87'P5E MAILING ADDRESS —1170('75- 94,01,EWaD Ave CITY ZIP TELEPHONE F0.171OWL) S 9�P -of ) C 14?5- 741,57- NAME ADDRESS CITY NAME r f tro CBL N 56- IF 1(_/ CSITY ZIP ZE !&LO-? TELEPHONE I 69LI d -st-0 - STATE LICENSE NUMBER EXPIMTION,DATE FILCoclno §?o &A01d 3 PROPERTY TAX ACC UNTIPABOEL NO. ? 7i62 WIQ,,9L1)_5:zj2r) NEW RESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL muLnFAMILY SIGN REPAIR 0 GRADING, FENCE X CYDS FT) 0 DEMOLISH TANK OTHER [i GARAGE o REMINING WALL FIRE SPRINKLER CARPORT L_ ROCKERY FIRE ALARM (ME OF 4SE. BUSINESS OR ACT EPW N: NUMBER NUMBER OF OF DWELLING I CRITICAL A I 11"A STORIES UNITS N DESCRIBE WORK TO BE DONE v1n r aa 7 gm P41 4- K11 ITNt /V.% E0 E 0 rA L i?fs 4pv-+ I./ 6tf aF9 ywtl 71. I rl'P- � AIAA rAP 7%&1 (22klr? PERMIT EXPIRES 6SE PERMIT I - ZONE _I NUMBER filot JOB SUITE/APT# ADDRESS _:? ssss�L 1; _5Aj PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I TESCIP APPMW MY Per(M Required S"M Use Permil Req�d EXISTING — PROPOSED Irispection Required Sidewalk Required REQUIRED DEDICATION— FT Underground lWanngroquavou 13 METER SIZE LINE SIZE I I NO. OF FIXTURES I PRV REQUIRED YES E3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE 41 VARIANCE OR CU SHORELINEORADB# INSPECTION BOND REO'D I POSTED OyEs ONO 1$ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED __XP , , , LOT COVERAGE RE OPOSED SETBACKS (Fr.) ALLOWED PROPOSED F RL11 SIDE REAR as "r Al A I PARKING T MMWfi"MfttD W DATE RFQ`D I PROVID 92! t I REMARKS 19 ON if Mi N ft a I CHECKED BY ITY=N OCCUPANT U GROUP SPECIAL INSPECTION REQUIRED [:] YES AREA OCCUPANT LOAD REMARKS PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REG'D 1-1.,0,60jff - Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit IG7 City Surcharge PLAN CHECK NOF- VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORD" ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPEM ONLX AM CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERmrrAPPLjcATiON1: ISODAYS PERMIT UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPILICANT, 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, WASHINGTOK-ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM, ANYAND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER, NATURE, APJSING 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 CITY`8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt #, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPUCATION AP PROVAL GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND.STAllf LAWS REGULATING CONSTRU - CALL.- This application Is not a permit until signed by the Fees TION; AND IN DOING TkIE �LVG��IZECFfHEREEFY/NO PERSON WILU3" ED IN VIOLATION -0P`1TrE%kkBOR CODEAK THE STATip', �F� RELATING TO W Building Off[clall or hlOer Deputy: and are paid, and FOR INSPECTION receipt is acknowledged in apace provided. 7. WORK E MPEN��UFOCE)WD ncw . 7. OfI5l41ALSSIGt01kTURE DATE SIG E 0 A ENT) DATE SJOAD 1425) %-Tlr- y/1 714 7 Z 771-0220 / IDATE RELEASED kTTENTICK 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- ORIGINAL -FILE YELLON- 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 ---- ------- ---