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20030729.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS Burka, Don MAILING ADDRESS 19351 22nd St NW CITY ZIP TELEPHONE Shorelina 98177 206-542-5812 NAME ADDRESS CITY ZIP ITELEPHONE NAME CBLN Day & Nite,'INC ADDRESS 16614 13th Ave W CITY ZIP TELEPHONE Lynnwood 98037 42-3-775-6464 STATE LICENSE NUMBER 99EC DAYNIPHO44CM PROPUBTY TAX ACCbU$ff( PARCEL NO. U37360 01403 —.db— NEW RESIDENTIAL 12 PLUMBINGIMECH ADDITION COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE E] REMODEL MULTIFAMILY SIGN E] REPAIR 0 GRADING CYDS C] FENCE X Fr) DEMOLISH 1:3 TANK OTHER GARAGE [:] RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIREALARM (TYPE % rE.�USfSfi OR ASCTWM EXPLAIN: n a U a PERMIT EXPIRES rSE PERMIT ZONE NUMBE JOB SUiTEIAPT# ADDRES152 L 916 92nd Ave W PLAT NA E/SUBDIVISION N70T No. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP Approved RW Psrrrdt Requked Street Use Permit Req'd EXISTING - PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION- FT underground Wiringfoquired METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE Nlype 1; or L vent connectors reqtdred ej, fud-b u , nIng upplMan im tinheatAd __ � s EERING REVIEWED waces. UA4r. 815.1.7 DATE FIRE REVIEWED BY DATE I VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND REO'D POSTED I 13YEs 13NO $ BEIRA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR Iz DATE PARKING REQ`D I PROVIDED I LOT AREA I PLANNING REVIEWED BY I REMARKS CHECKED BY GROUP NUMBER OF NUMBER OF DWELLING CRITICAL AREAS 1- 9 1; SPECIAL INSPECTION 11514�c _Ar r A OCCUPANT STORIES UNITS NUMBER REQUIRED 0 YES JAREA LOAD DESCRIBE WORK TO BE DONE Install nsw gas furnace REMARKS f PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG'D replace existing same for same MUST BE -7h,,ovoi A�z- 1-5 GAS PIPE IEST raw nairlur ilasonrnTnn VALUATION AFFIDAVITS SHALL NOT $ BE ACCEPTED Description FEE Description FEE Plan Check State Surcharge E GLAZING % LOT SLOPE % 4M 1 Building Permit I - City Surcharge 61) 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, DRArEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: ISO DAYS PERMIT LIMIT: I YEAR - PROVIDED WORK IS STAFMO WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 1APPLICAUL ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST. AGREES TO INDEMNIFV: 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 Landscapeinsp. Total Amt. Due DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - I Recording Fee Receipt III I HERE13Y 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 until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or histher Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided. WORKMEWS COMPENSATION INSURANCE AND ACW 18.27. OF LS SIGNAVRE DATE 871GNAT DATE SIGNIM (425) VIX AA,,A,7i . qh7lA 771-0220 KZE464,1- S1,41 -1 K-Z- RfL/641#15 idy DAT)f EXT 1 3 - 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 I 4 DATE RECEIVED CITY OF EDIVI ONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS Burke, Don 15 MAILING ADDRESS 19351 22nd St NW ZIP TELEPHONE Shoreline 981771 206-542-5812 NAME ADDRESS CITY ZIP TELEPHONE NAME CBLN Day & Nits, INC 19 L7. ADDRESS 16614 13th Ave W CITY ZIP Lynnwood 98037 TELEPHONE 425-7751-6464 ,.STATE LICENSE NUMBER EXPIRAT19N DATE DAYNIPHO44CM 9RECKED BY PROUn T)t ffidffCrr�t 50. 0 NEW RESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN REPAIR GRADING CYDS 0 FENCE I _ X_FT) DEM`OLISH TANK OTHER GARAGE RETAINING WALL FIRE SPRINKLER CARPORT 0 ROCKERY FIRE ALARM OWE 1CA nffTESfl SLtSCnVITY) EXPLAIN" NUMBER OF" � STORIES_ j NUMBER OF / DWELLING UNITS r CRITICAL AREAS NUMBER Y4114 DESCRIBE WORK TO BE DONE Install new gas furnace replace existing same for same �70 lom ATZI I-S :jME GLAZING % LOT SLOPE PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIUS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DORILAIN (CURBS, SIDEWALKS, DRIVIEINAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PIERMITAPPLICATION: 180,DAYS PERMIT UHM I YEAR - PROVIDED WORK 19 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, IT$ OFF10ALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTUYOR INDIRECTLY FROM THE ISSUANCE OF THIS PERMrr. 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I HEREBY AW40WLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GM 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- TIM. 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 WOMWEICS COMPENSATION INSURANCE AND RCW 18.27. DATE SIGNED Y,2 PERMIT EXPIRES=a;:eL 6SE ZONE PERMIT NUMBE"-. JOB SUrrE/APT# AIDRES12 19 16 92nd Ave W PLAT NAME/SUBDIVISION NO. LOT NO. LID NO, LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TEsur Approved 9w Psm-A Requk6d street use Pennat " EXISTING - PROPOSED kispecdon Required SIdswalk Raquir6d REQUIRED DEDICATION- FT UndwWWW wiring required METER SIZE LINE SIZE _[ I NO. OF FIXTURES PRV REQUIRED I YES C3 NO 13 REMARKS FIRE REVIEWED BY B or L vent connector$ -ed on fuel-buriflng applM DATE ul H-IMIM I � VARIANCE OR CU SHORELINEORAD" INSPECTION BOND REO'D I I POSTED 13YEs 13NO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR DATE PARKING LOT AR EA 'm LANNING REV Y REO'D I PROVIDE� A REMARKS Lm I 'H�CKIED BY JTY�� ,jTRuqnON OCCUPANT GROUP SPECIAL INSPECTION JAREA OCCUPAN 1. REQUIFIE[ YES LOAD IEMARKS is 3ROGRESIS INSPECTIONS PER UBC 109fFINAL INSPECTION RE= § _,f_%M6 ninr -rrair maim-P nr- IN VALUATION $ WIN= SHALL NOT E ACCE"ED Description FEE DescrIpUon FEE Plan Check state surcharge Building Permit no City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit -Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording ee Receipt Al = CALL FOR INSPECTION 1425) 771-02020 APPLICATION APPROVAL This application Is not a permit until signed by tho Building Official of hlWbef Deputy: and Fees are paid, and receipt Is acknowledged in space provided. OF $BIG RE DATE 147. tit RiLEASEt DATIFF EXT 1333 - IT is UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLON-INSPIECTOR'A CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD-ASSE 04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING t z 0 =1 0 ITI :;:a in � 2 M M 0 -48 0 C :2 E fn- m 10 � z 0,n ,3n! I M M 0_0 0 017 n C z M 0 z 0 :1 0 M