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20030704.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS I- P011,110% I C MAILINU AUL)HESS - - K 7s,72,q CITY ZIP jTELEPIj4ONE G Q..&j 0 Af 5 S C -e t q NAME ---j 1 13 ? _ I ADDRESS . , I I; Ij Orl IL C!L�LU� 1- LL I L QLC-61L 15 4- CITY ZIP TELEPHONE S (L AeTTLC- I NAME 2910eaL 2 1 ICBLN CITY ZIP TELEPHONE STATE LICENSE NUMB R EXPIRATIONDATE I CHEEKEDBY T.— PROPE \ACCOUNT PARCEL NO. NEW ADDITION /REMODEL RESIDENTIAL XC OMMERCLAL MULTIFAMILY WOPLU�MBING I ECH COMPLIANCE OR CHANGE OF USE SIGN REPAIR DEMOLISH GRADING CYDS TANK o FENCE X FT) OTHER 0 GARAGE RETAININGWALL CARPORT ROCKERY 0 FIRE SPRINKLER FIRE ALARM M?E OF USE, BUSINESS OR ACTIVITY) EXPLAIN: ---n r- (1 At)- AV 7 NUMBER OF STORIED NUMBER OF DWELUN -UNITS -WIA. -&RrriCAL AREAS I NUMBER V114' DESCRIBE WORK TO RF DONE HEAT PLAN El % I LOT SLOPE—% I VESTED DATE — iZ,2 -62 0< Z I THIS PERMIT AUTHORIZIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T; BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBILIC 3 DOMAIN (CURB$, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SFPARATEPERMISSION. 1 5 PERMTTAPPLJCATION: ISO DAYS L PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION *APPLICA?9 ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AN ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLEY) 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 ClTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE ouLy AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMP Y RELATING TO IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON Lo ED WORKMEN., CpWkNSATION INSURANCE AND RCW 16.27. DATE SIGNED OT-17-03 A-1713"ON IT IQ "Kit Auuc" [PERMIT EXPIRES USE ZONE PERMIT NUMBER Cftj C19 JOB 4�29 ADDRESS'tZ,,? PLAT NAdE/SGIBDIVISION NO. L6T NO. I to NO - I LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP AW Pem—equiled EXISTING StM& PROPOSED- in Ited Sisd=:�Iured REQUIRED DEDICATION — FT Undergrowd Wftg required 13 METER SIZE LINE SIZE FIXTURES PAV REQUIRED YEA NO 13 WEMARKS — OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE leltl) C' FIRe tOINED 0 �TE rL VA61ANCEORCU SHO VINE OR ADS# INSPECTION BOND k Lot— % rho) REO'D POSTED S ONO is SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR �LOT AREA ., N� 0 REVIE1 PARKING PLANNING REVIEWED, BY REO`D I PROVIDED REMARKS f J, CHE&�E 0 �9EJKN LICTION CQPE OCCUPANT X/I 7 f�&7 I GROUP A----z SPECIAL INSPECTION JARE OCCUPANT —1 REQUIRED [:] YES ;774:�l LOAD j� j4q Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection M. 0 : Fir La Re PER UBC 108/FINAL INSPECTION REaD MFEE Description State Surcharge City Surcharge FEE U ev ew e5l) Plan Chk. Deposit j e Inspection 1TbtaIA Receipt # 01 ndscapeinsp. tt.Duee cording Fee I Receipt # APPLICATION APPRO CALL This application is not a permit unto SIgnec! by the IR INSPECTION Bullcung Official or histher Deputy: and Fees are Paid, and 1000IP1 13 8011010dodged In space provIdod. D [GNAT DATE (425) 771-02.20 -RE D BY ID —ATE rZ) EXT 1333 Z i 1- W Liar- Un U%XUPY 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 ORIGINAL - FILE YELLOW - INSPE 04/02 PINK -OWNER GOLD -ASSESSOR PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING 4 'Jd BALWATER DEPARTMENT t *PRaEV6ENTION ASSEMBLEY TEST AND MAINTENANCE REPORT NEW INSTALLATION 1�011 - FILE NO. OROM NOW-WATION LEMR) 19 Reduced Pressure Assemblies Pressure Vacuum Breaker Airgap Double Check Assemblies Air Inlet Check Valve Relief Inspected Valve I st Check 2nd Check Opened at psid psid Approved I'al psid psid Opened at Failed 0 Test DC -closed tight x Closed tight CJ 44— psid Did not Leaked 0 Leaked 0 open 0 Leaked I.] Comments: RP. psid Repairs and Materials Used CASS Test DC -dosed fight 0 CAosed tight 0 Opened at Opened at After RP- — psid psid psid psid Repairs RV-CEIVED OCT yh 2003 DEVELOPMENT SER1410ES CTR- CITY OF EDMONDS INSPECTED/ TESTED BY 101- DATE 9,3o—o,5 REPAIRED BY DATE FINAL TEST BY DATE TESTER'S WASHINGTON STATE CERTIFICATION NO. B3044 TEST EOUIPMENT: MAKE kJVA5 MODEL I'K-" " SERIAL# QtQ 4n GUAGE CALIBRATION DATE t4 —14 -05 TESTER'S TELEPHONE NO. *7 -Awow—i-7. �11A , q",y N,� TO PERMITTEE AND/OR OWNER IS At 01. 1 F�j' S 91 DO NOT REMOVE PARTIAL APPROVAL CORRECTON REQUIRED ENFORCEMENT VIOLATION 0-7 7ic4 Owner —Permit Number c;) -73 4�9 L�C (3- Job Address jQLQQ9-fj02§ite Contact WORK DESCRI[BED BELOW HAS BEEN INSPECTED AND IS APPROVED L3 APPROVED PLANS AND JOB CARD MUST BE AVAILABLE TO INSPECTOR ON SITE CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE NEXT PHASE OF WORK IS STARTED j;50 0 RECALL FOR INSPECTION )4REINSPECTION FEE MUST BE PAID PRIOR TO INSPECTION REQUEST STOP WORK -UNTIL AUTHORIZED TO CONTINUE BY CITY INSPECTOR RK mp ITH NO PERmrr.sTop WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WO CO LY W ALL APPLICABLE CITY CODES '4 -7 Y?- U irt THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED TO BE CORRECTED WITHIN CALENDAR DAYS OR PENALTIES MAY BE APPLIED. FOR INSPECTION CALL 425-771-0220 Fire Public Works )KrBuilding Planning L3 Engineering inspector Date White: Permit File Pink. Enforcement Buff: Applicant 5 1 JI z FINAL PROJECT APPROVAL FORM z 9 0 m =i ii vi ;I OM a ma 0 80 c -4 C MM MZ 3: (j) 0 -n n --I m m 0 0 0 M C cj) c co) M 0 Z .q X z 0) z 0 m RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Si ocaprvl.doc.l:tenip:bldg:fonnsIO/OI FINAT, PRO.YP.r.T APPROVAL FORM z 0 m :; 9 vj ;I am c rn 0 80 c M rn Z co) 0 -n n m m 055 0 r- 0 m C ch c CD M 0 Z z 5� CA z 9 0 m RE -IN I SPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Sign, ocaprvl.doc.l:temp:bldg:forinsIO/0.1 z 0 m :;:9 V5 --I om c MO 0 80 c qc .x m mz co) 0 -n n m m 0 0 0 M C (0) c (1) M 0 Z r- z z 0 m 3. RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date ocaprvl�doc.l:temp:bldg:formsIO/OI I Jew LI I 41* ;k 4, T, ILL 40 L boat q 0 It ..4 P ILL it'It Arc -A� :;R-O JAR Ak AiL. 7 1 ge- 7 ILL Lt! ILL m I ILL ILL ILL: LP- ILL ILL I., I L L I L ILL t ILL 'L. el- L r M. L,1 m ILL. ILL- Lt ILL Let I d 1.4 1 0, "l;, ILI m r mL Afa -I pi R L' ILL go. f Lt, I 1 41 ILL Lt. % A OMAN rk-L Let, .4T.f 4 ILL la LL At I gmmmggg�gft n L 0 UA I I 0 4 1 . 4 LT ILL. Ck= pf 14, "tit" I :i ILL., . r Ir IT �V,LLL ILL, 1111111111111h PIT X�g, ILL sm, 4 LN' gt�; � , I I . ; 'r.y ILL. ILL L. PL 4 ILL. ILL L At ImI'LlIgg -I I L , f ,, OF in till At Ts P.e Lt I AIL ILL Ap, LOLL. L It L Lot r W4AT GWA= LL uUme. I I ILL L L L. r I I it.0 I Woo storisso ILL, NOT L ILL L. 7'. 4-.4. ILL:* LL Lot. Lei —L:g; MA LL L. .11 -11, 0 'g'LT'; P.� "L I III d. g, 1 LL I 10021 ILI Le L :4. ILL ILL I ITHt REOUREMOM I., ORr LL, L, 111. -1 L I I li� A= )ILL: Occupmcy Im r + . I w/ I m LrL ILL, + ILL r ILL L-Amu" I'LL L. L a OFF aft. L LIO ,L L ILL r ILIL, + r WOO ILL L IL "fWftmw%Qdgg"MdOr N m F-W WW *0 be ""rad in "W=nd&m ot do Omo *W dwnp afamosmy or ms a**" a gpwwAw4&qww L yjj!�Jjvwl - :Paw In L Ito L I I'LL, Lt ILL, 4r ;. , I I'LL. 1,L) I L ALL .. L-L-LILL ILL I I dl CIL ILL, Lek :j; wi ft ILL.. ?Ittlr, i + lt', . L'A , 4 YIX I IOLLOL I ILL ILL ILL.J. Lt IL LL It LLII .Lit -IRV 'Olt, I 'A� EIVED PERMIT EXPIRES CITY OF EDMONDS USE PERMIT ZONE 'NUMBER CONSTRUCTION PERMIT APPUCATION JOB S ADDRESS"7 OWNER NAME/NAME OF BUSINESS Cc C- 0 v C) uto t PO VL 0 1 K C PLAT NAM E/SUBDIVISION'NO, L6T NO. LID NO. MAILING ADDAEBS LID FEE $ -7 t7 Zq 4- c t (r C A -/ 7ESCP Appmod PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pamd Requ, ad 0 CITY ZIP TELEPrN� C_ e stmet U" P d EXISTING - PROPOSED Impection SidewA Requke4 0 MOAJ�'� REQUIRED DEDICATION Fr Underground WMg req" NAME METER SIZE LINE SIZE NO. IPF FIXTURES, \PRYJREQUIRED 6A(U-46CAJ (U 11V 6-sokl .. ., N 1Lf .1 z NO 13 ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR ER06IONICONTROLIDFMINAGE a C tA) r 1? 114 /2 'V CITY ZIP L TELEPHONE Al C_ 10:51 10 4 6 9 1 -7 NAME eLN �G *INE'*E,'R E N. I N G R EV -D BY DAT FI ED 0 TE CITY TELEPHONE -a 0 IANCE)IK CO. SHO R AOB# INSPECTION BON STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY. REQ-0 POSTEDD. "tlk 10YES 13rin s BE B%V- SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. QOMPLETE EXEMPT ALLOWED OPOSED ALLOWED I PR - OPOSED M C: 0 0 0 12 0 Q EXP M 0 LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SET13ACKS (Fr.) �PL61�IBING ECH 0 [:3 NEW. 1:1 RESIDENTIAL �LLOWED PROPOSED FRONT SIDE . REAR FRONT LIRSIDE REAR C: ADDITION, OMMERCLA�_� COMPLIANCE Oft 32 3: 0 C"GE OF USt_\ PARKING LOT AREA LANNING REVIEWED BY M '4 06 J�t /REMODEL' 'MULTIFAMILY REO'D PROVIDE SIGN*., 1P 10 FENCE z 0 1:1 X FT) REMARKS 0 OTHER DEM'OLISH _k 0 GARAGE '%ETAINING w�LL F RE SPRINKLER -n CARPORT 0 ROCKERY FIREALARM "—f Cc). 1"4 U. 'ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPMUCTION CWE OCCUPANT Irn M 1 _A_U A,AJ GROUP 2'GHT PROPO SETBACKS R $JOE RE BED (FT.) AR _T NUMBER NUMBER OF CRITICAL A-3 JARE OCCUPANT OF DWELLING AREAS' SPECIAL INSPECTION 6 0 LOAD 0[; STORIEiI U NUMBER REQUIRED [j YES C: 0) 47 DESCRIBE WORK TO BE DONE C C0 ,V REMARKS M PRJOGRESS INSPECTIONS PER UBC 08/FINAL INSPECTION.REQ-D Pm 11 41 t, U I P -AILLIL 4- 2:Z7 r_� 4 2ut ink 0,31 VALUATION z IAK2.20 ce_ 4oY Description FEE Description. FEE z 0 Aj%jPlan Check State Surcharge da 0 HEAT SOURCE GLA7JNG % LOT SLOPE % Building Permit .13 5 City Surcharge M PLAN CHEC VESTED DATE Plumbing / 10 1 M_ Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: 3 BE DOME ON PqIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading :3 DOMAIN (CURBS. SIDEWALKS, DRIVEVAY8, MARQUEES, ETD.) WILL REQUIRCE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION' 180 BAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit /L)i? ;APPLICANT N NTERE T, 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 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # 2, I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECr 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 TWs application Is not a parMft Until signed by the TION; 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 FOR INSPECTION BuildIng Official or hWMr Deputy: and Fees are paid, and r"pt is acknowtodged in space Provided. WORKMEN11 C��NSATION INSURANCE AND RCW 16.27. O�Fql Cr I I I NA DATE SIG R GENT) DATE SIGNED (7u� 07- 11-31 771-0220 ION EXT 1333 REV19QED BY DATE IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L 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