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20030735.pdfM b�tE RECEI CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS !E�� C-4 MAILING ADDRESS ttn ---t— CITY ZIP TELEPHONE le _V NAME ADDRESS 1 k5N U'j - 52:21" 75�� CITY ZIP TELEPHONE ADDRESS e".51 N - 1W-L CITY ZIP TELEPHONE P_1A Al ,--L, 3 6zo -751-1-5zj STATE LICENSE AUMBER I n + I I zj 6 )KNEW PLUMBING/MECH COMPLIANCE OR ADDITION COMMERCIAL 1:1 CHANGE OF USE REMODEL MULTIFAMILY [3 SIGN REPAIR GRADING CYDS FENCE 1:1. ( X FT) 0 DEMOLISH TANK AOTHER oGARAGE RETAININGWALL 13 FIRE SPRINKLER CARPORT ROCKERY FIREALARM (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER OF NUM OF DWEMG JIA CRITICAL AREAS I STORIES UNITS NUMBER DESCRIBE WO$K TO BE DONE C_ HEAT SOURCE T GLAZING % LOT SLOPE % PLAN CHECK ND�, VESTED DATE THIS PERMIT AUTHORIZES ONLY THLfWORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS 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 BE D D TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE OR LIMIT IN ANY WAY THE CRYS 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 DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABQIL—COW OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSY101ji-140"CE AND RCW 18.27. SIGNATUE (OWNER Ov5wr�_ DATE SIGNED I . — 6 . ...:;? &,—, V1 I 1 —11 _s PERMIT EXPIRES td IN USE PERMIT ZONE 15Cl/ NUMBE&O, &:�3&5 JOB SUITE/ ADDRESS 0 aL n ese- PLAT NAME/SUBDIVISZ�T No' LID NO.. LID FEE $ TESCP Approved 13 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit ReWited Street Use Faffnit Req'd EXISTING — PROPOSED InaractIon Aequired Sidewalk flectuirad Unftrground REQUIRED DEDICATION— FT WiftgreqWed 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES C3 NO 13 3 REMARKS I OWNERICONTRACTOR RESPONSIBLE FOR EROSIONCONTROUDRAINAGE 1'� S? fJM 1) ' (-=rh <,- / o tJ , r-1 K A t- WNEERING REVIEWED By DATE 6 ( L*ex-r- q Ilk]# -3 FIRE REVIEWED BY DkE IEL VARIANCE OR CU SHORELINE OR ADB# -1 INSPECTION BOND RECI'D I POSTED 4( 13YES ELO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 'XP LOT COVERAGE REQUIRED SETBACKS (Fr.): PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR 7W PARKING LOT AREA PLANNING REVIEWED BY DATE REO'D PROVIDED I 91 REMARKS CHECKED BY OF CONSTRUCTION OCCUPANT 1,TYPE GRO k3_ SPECtALINSP CTION AREA OCCUPANT REQUIRED 9YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D VALUATION $ q&5 Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk- Deposit Fire Inspection Receipt # Landscapeinsp. Total Amt. Due Recording Fee CALL FOR INSPECTION (425) 771-0220 APPLICATION APPROVAL This application Is not a permit until signed by the Building Official or histher Deputy: and Fees are paid. and receipt Is acknowledged In ��Provlded. OFN I SIGF/� DAJ4 1 ML., P RELEASED B ATTENTION I rA I I U 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 FINAL PROJECT APPROVAL FORM z 0 m :; 9 m c Ma 0 80 c q r. MM M� Z 0 -n m m 0 V5 0 o Fn C M 0 Z X z -q m V5 z 9 0 m 2. 3. RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL Sip, ocaprvl.doc.l:temp:bldg:formsIO/OI RECORD OF INSPEC'TIONS INSPECTOR DATE APPROVED'.,, SETBACKS ..................... FOUNDATION: Footing...................... wall ................. ......... Pler/Porch ................. Retaining Wall ...... In. g, Slah Insulation ............ Y, �e Giftj va_rlcll� . "IR"11 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUI INESS J G I A A-T�j PERMIT EXPIRES , /4 loo USE PERMIT ZONE N U M B E JOB S ITE/jrvim ADDRE;S t10 5LA, n se- +_ hvl� ___� I zi�y-nc) 'n Cj PLAT NAME/SUBDIVISION NO. NO. LID NO. :� MAILING ADDRESS ' 1 -1 LID FEE $ 7ESCP APP"ried PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pa(mit Required, 15;x4 r_.1 Streel Use PeffilK R qV EXISTING — PROPOSED Inspecdo I RequkW E3 CITY Zip TELEPHONE Sidwalklew1rod 13 UndoMmund REQUIRED DEDICATION— FT eq 11 7"' u.— METER SIZE S-17PR NAME LINE Sli7NO. OF FIXTURES PRV REQUIRED YES-1-3 NO 13 L-heryl AfA z I t �Z-K if %E ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 19 1 5z--14 �� MD'. Mswil, EMIL ZIP ELEPHONE NAME .0, E RING REVIEWED BY DEE ADDRESS FIRE REVIEWED BY DATE CITY ZIP TELEPHONE BOND VARIANCE OR CLI SHOREUNEORADB# INSPECTION STATE LICENSE NUMBER EXPIR,101 DIE KED REO'D POSTED 105-4 I . I I . - 0-0-0 t [IYES MWO $ I I V% + -e I I R SEPA REVIEW SIGN AREA HEIGHT PROP I L COMPLETE EXEMPT ALL PROPOSED ALLOWED PROPOSED A< -- C/3 , EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) )&NEW PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR OR COMPLIANCE I El ADDITION COMMERCIAL CHANGEbF USE I PARKING LOT AREA PLANNING REVIEW ED BY DATE REMODEL MULTIFAMILY SIGN REQ`D PROVIDED -f GRADING FENCE REPAIR CYDS ( X_FT) REMARKS _ OTHER D E 0 MOLISH',. TANK A GARAGE RLTAINING WALL F RE SPRINKLER CARPORT ROCKERY 'M FIRE ALARM (TYPE.OF USE, BUSINESS 0 EXPLAIN: CHECKED BY NSTRUCTION OCCUPANT TYPE OF CO �"� f2��3 I GR NUMBER IMBER OF CRITICAL OCCUPANT OF - - 0 � 'I NDWELLINS AREAS SPECIAL INSPECTION LOAD dIA I JAREA STORIES UNITS NUMBER REQUIRED 0 YES , IBE W�K TO BE DONE .-PESCIR REMARKS PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTI ON REO'D UU VALUAnON $ q0 Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK rj,_ �0 VESTED DATE Plumbing Mechanical TMB PERMIT AUTHORIZES ONIV THNITRIK ;OT ME. THIS PERMIT COVERS WORK TO I= BE DOME ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUBLIC Grading 3M DOMAIN (CURBS, SIDEWALKS, DRIVIONAYS, MARQUEES, ETC.) WILL REQUIRE t: SEPARATE PERMISSION. Engr. Review PERMITAPPLICATION: ISO DAYS PERMIT LIMIT I YEAR - PROVIDED WORK IS STAFFFED WITHIN 180 DAYS Engr. Inspection SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION 'APPLW". 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 # ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY SHALL NOT BE FROM THE ISSUANCE OF THIS PERMIT. 18SUANCE OF THIS PERMIT Landscapeinsp. Total Amt. Due DEEMED TO MODIR, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Receipt # Recording Fee I HEREBY ACKNOWLFDGE THATI HAVE READ TWS "APPLICATION; THAT THE INFORMATION APPLICATION APROVAL GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREt To COMPLY WITH C17Y 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 hisiber Deputy: and Fees we paid, and IN VIOLATION OF THE LAGO.ELOODLE OF TH STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowiodged In Wcq pfoAdod. WORMERS C0MPENSPtViN_"CE AND RCW 18.27. OPP SIGN -41 DAM SIGNATU E (OWNER DATE SIGNED (425) V-0 kQ�_ 0 ---- 771-0220 -RELEASED BY FIATE ArriNTIO' Off 1333 IT IS UNLAWFUL TOLE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN& - FILE - YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR 04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING i z 2 0 M =i5i a; � M MO 0 -10 0 M jo z O"n. M M a ai 0 0 Fn- C 0) 0 ca z 9 0 M