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20030677.pdfDATE RECEIVED lo USE CITY OF EDMONDS ZONE JOB CONSTRUCTION PERMIT APPLICATION ADDRESS qC1 09 0 NAME/NAME OF BUSINESS .9 PERMIT EXPIRES -.,6/4 -7 PERMIT NUMBER SUI E/AP # 3' 1*.%Y* % V_1% n 0 (1 1 (1 1 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. MAILING ADDRESS (:VA09 122512—" <__ji CITY ZIP TELEPHONE E6 Ct zz�i�l NAME 6 ADDRESS C3 %I — I CITY ZIP TELEP�ONE NAME nj CV e-ra I A ----- ADDRESS - 4 j 431a & Pat 41SO CITY Z' TELEPHONE 5- eao4a, C�,?,)U� 12, 0 It e - I t 2,5 - 1,CS! STATE LICENSE NUMBER X E ' X IRATION DATE C L _fSoe PROPERTY TAX ACCOUNT PARCEL NO. M,3q I L� — bo— oco)(p NEW RESIDENTIAL g--P—LU�MBINGEC ADDITION COMMERCIAL o COMPLIANCE OR CHANGE OF USE REMODEL APARTMENT 0 SIGN REPAIR [3 GRADING o CYOS FENCE X I FT) DEMOLISH TANK OTHER [3 GARAGE CARPORT RETAINING WALL 0 ROCKERY RENEWAL WOF USE. BUSINESS OR ACTIVTM EXPLAIN: yp M NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS I I NUMBER DESCRIBE WORK TO BE DONE +0 ok _IJ AN 1� WtIJ( Lla:A_�Zg WAL 6_4 Jb oil HEAT SOURCE GLAZING % LOT SLOPE % =;!�'5 1 1 PLAN CHECK NO: I VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 1180DAYS PERMIT LIMM I YEAR " PROVIDED WORK IS STARTED WITHIN 180 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 NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE 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., 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- TION; AND IN DOI H E�w OP L ED THEREBY NO PERSON WILL BE EMPLOYED OR NG T 0 OF E IN VIOLATION TH -;�ODM OF HE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATO;�q�NCE AND RCW 18.27. - -_ --- A SIG URE �OWNER R GE DATE SIGNED LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Parrill Raq'd EXISTING - PROPOSED inspection Required 13 Sidewalk Required 13 REQUIRED DEDICATION- FT Underground vvinng r ulrad METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED 115 I I YES 13 NO 13 z I I REMARKS z OWNER/CONTRACTOP RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED/DATE FIRE REVIEWED BY DATE W Ic I M VARIANCE OR CU SHORELINE OR ADO# INSPECTION BOND REOID POSTED E3 YES [3 NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED_ EXP , , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT IJRSIDE REAR DATE iz PARKING LOT AREA I I PLANNING REVIEW ED BY REO'D I PROVIDED REMARKS CHECKED BY OCCUPANT /2 JTYP:,�e C� GROUP —7 SPECIAL INSPECTOR OCCUPANT REQUIRED [] YES JAREA LOAD REMARKS 1 PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ_ 9 A717TENTION 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 1010i 0 In VALUATION $ Description FEE Description FEE Plan Check b4sl'- '30, to Building r)tj—+- uo te, 20 - _C� Plumbing j W, co Mechanical 6 .0c Grading Recording Fee Engr. Review City Surcharge Engr. Inspection State Surcharge Traffic Mitigation Plan Chk Deposit Fire Review Receipt # Fire Inspection TotalAmountDue jnc�> Landscapeinsp. Receipt # VIA P LICATION APPROVAL CALL his pplication Is not a permit until signed by the 1crfaipt Bul Ing fficial or his/her Deputy: and Foes are paid, and FOR INSPECTION ( is acknowledged in space provided. Cl S I NA14 67 1 DAYE TURE (425) Z_ / 1-3 WEASED 771-0220 BY DATE EXT 1333 771-0221 ORIGINAL -FILE YELLOW- INSPECTOR FAX PINK -OWNER GOLD -ASSESSOR k z 0 1 0 ITI -I -n V5 � a M C M 0 0 0 C: � K ITI 171 fj) 0 _TI rill M ITI 0 0 0 M C (j) C Cn ITI 0 Z r- z z 0 ITI L1 RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDA'hD Footing ...................... Wall .......................... Pier/Porch ................. Retaining Wall ........... Slab Insulation .......... PLUMBING: Underground ............. Rough -in ................... Commercial Final ...... HEATING: Gas Test .................... Gas Piping ................. -,Equipment Commercial Final ....... EXTERIOR SHEAT HING NAILING .......................... FRAMING ......................... FIRST FLOOR FRAMING... NSULATION ...... ............ Floor Insulation ......... Wall Insulation ........... Ceiling Insulation ....... SHEETROCK NAILING ... SPECIAL INSPECTION ... MISCELLANEOUS .......... FINAL APPROVAL FOR Vill CIS OCCUPANCY .................. 4" 00 4�16 7 71 C>1 I CITY 66 NAME CITY NAME N A R R D C OF PLAN ATE RECEIVED ERMITEXPIRES 10FP,_ 10 USE CITY OF EDMONDS ZONE NUMBER ' U )INSTRUCTION PERMIT APPLICATION JOB ADDRESS OC- SPITE/A I 's IJ AME/NAME OF BUSINESS <�K a \ VV) e, PLAT NAME/SUBDIVISION NO. 1 LOT NO. LID NO. kDDRESS 0 -2_?_J2_nd I LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET M AP TESCP ApPrDv*d RW Permit Required ZIP TELEPHONE EXISTING — PROPOSED Street Use Permit Req'd inspection Required Sidewalk Required �i5, ?,0-2A REQUIRED DEDICATION— FT Underground Wiring requW 13 METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED a YES 13 NO C3 z REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z 11 ZIP TELEPHONE I�AA S e-ra I A ENGINEERING REVIEWED/DATE FIRE REVIEWED BY DATE Zffi TELEPHONE LIAI -1 � 4L (:�q, PZC)Lp- I Qs— I, :NSE NUMBER EX RATIO Z11 N DATE C ia ? r44 0± Or TAX ACCOUNT W-1— C) t) C) — 00to —ao RESIDENTIAL *-_�LUMB�N�G -EaMPLIANCE OR TION COMMERCIAL CHANGE OF USE DDEL APARTMENT SIGN UR [3 GADING CYOS [3 FENCE X FT) OLISH 0 TANK [3 OTHER kGE RETAINING WALL,.,' �ORT ROCKERY RENEWAL SLISINIEISS'OR ACYMM�O(PLAIN:- A.Q_ ce, NUMBER OF CRITICAL DWELLINCI AREAS UNITS I I NUMBER WORK TO BE DONE +0 C 4 6 Te. � C--,l Ila ,�) .0��.ej he A7' rffPA 4b 0i an, NO: 00 bTU LOT SLOPE % VESTED DATE VARIANCE OR CU SHORELINE OR ADB# INSPECTION I BOND REO'D POSTED C3 YES [3 NO SEPA REVIEW SIGN AREA I HEIGHT COMPLE1. . EXEMPT ALLOWED . PROPOSED ALLOWED , PROPOSED LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT 'SIDE REAR., �FR IA SIDE REAR 7[UR DE PARKING LOT AREA *X,4,NNIt Rf'EV_iEWED BY DATE REO'D I PROVIDED I CHECKED BY ITY1I SPECIAL INSPECTOR JAREA REQUIRED [:] YES REMARKS PROGRESS INSPECTIONS PER LIBC VAWATION $ Description FEE Plan Check Building Plumbing Me6hanical THIS F BE 0 ERMrr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO DOME ON PWATE PROPERTY ONLY. ANYCONSTRUCTION ON THE PUBLJP MAIN (qURSS, SMEWALKS, DRIVIEWAYS. WGUEES ETC.) vALL R I I SEPARATE PERMISSION. Grading Engr.'Review IL P7MIT PERMIT APPLICATION: 180 DAYS UMM I YEAR - PROWDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection "APPL ICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Traffic Mitigation IN INTEREST, EDMONDS, ALL C FROk DEEk AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS .. E CITY OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND LAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE ED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Review Fire Inspection NOR I JMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Landscapainsp. I HERESV GIVEN 11 THE OW? TION; AN) k IN VIO WORKOWM ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF ER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- IN DOING THE! WORK-Mr4ORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL r IN OF THE F THE STATE OF WASHINGTON RELATING TO FOR INSPECTION L R OD7 E 8 COMPENSAT;� 1=SN AND RCW 18,27. tbwNER kR�GEN7),.�, DATE SIGNED (425) 771-022.0 i,_ 4TION EXr 1333 SIG%ATU0E E IT IS Uh A FINAL -AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE 0: OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FM 10/01 OCCUPANT GROU OCCUPANT LOAD INSPECTION REO'D ,cn Description, FEE '30. 0 - 2-0. oc Recording Fee City Surcharge State Surcharge Plan Chk Depos t Receipt # Total Amount Due Dr:> C61- Receipt # zzbim Th�EljpllICATION APPROVAL a p P! ication Is not a permit until signed by the ding IcIal or his/her Deputy: and Foos are pald. and 0icelpt Is acknowledged in space provided. �flc; I NATURE DA7�E 2 Y Z. / %BED BY DATE ORIGINAL - FILE YELLOW - INSPECTOR PINK - OWNER GOLD - ASSESSOR 0. j z 0 ITI M M 0 0 —40 0 C= M ITI Z 0 -n n --I M M a Fn 0 o Fn C ch C V) M 0 Z-1 Fn 11� z 0) z 0 1 0 ITI