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20030752.pdfI DATE RECEIVED I J CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OW .V�_"EINAME OF BUSINESS J g. S.5 I it. L o MAILING ADDRESS 5 2. 0 '5 cou"i 0 VA1. L' CITY Z TELEPHONE Or-lioil-45 22L 449'T2 NAME L -Tri C. ADDRESS C*Slk Avc :A: CITY I P TELEPHONE 9 5- 1 �Q -7 -79 42.9 NAME jCBj# ADDRESS jq7�21 ZIP I TELEPHONE LICENSE NUMBER EXPIRATION DATE I CHECKED BY PROPERTY TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL 0 MULTIFAMILY REPAIR GRADING 1:3 CYDS rl DEMOLISH 0 TANK 0 RETAINING WALL oGARAGE CARPORT ROCKERY (TYPRF UfE. BUSINESS ORAff"10PLAft. PLUMBING / MECH 1:3 COMPLIANCE OR CHANGE OF USE 11 SIGN oFENCE ( _X—FT) OTHER FIRE SPRINKLER FIRE ALARM NUMBERI NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE Re-DIC.ClAQ 013 00—s' -fu'.r-/ HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 3 DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT ILIMM 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, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAJMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORD114ANCE 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 DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WOR S COMPENSATION INSURANCE AND RCW 18,27. SIGN DATE SI NED I t3 �_144 I PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS 5�K) Seckr�iov,5� Lo PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESUP Approved RW PerreA Requited Street Use Permit Raqrfd EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground I wmg toque — METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES 13 NO 13 z REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 1 GAS PIPE TEST MUST BE ENGINEERING REVIEWED BY HI- 1111:11:11-1i I PI I DATE FIRE REVIEWED BY DATE i I VARIANCE OR CU SHORELINCORADE111 I INSPECTION 1$ BOND REO'D POSTED 13YEs 13NO $EPA REVIEW SIGN AREA I HEIGHT COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR z PARM Evil PED BY DATE REQ`D I ol VIDE "B or vent connec r.,% r ri. equired on fuel-bu.ming appliances In u ",I nheated spaces. UMC 815.1.7 ---I �QDE I OCCUPANT CHECKED BY ITYIE OF CONSTWUCi�;N "1 1, 114.1y.-D GROUP SPECIAL INSPECTION [AREA UGGUFANI REQUIRED LOAD REMARKS PROGRESS INSPECTIONS PER UBC 11108/FINAL INSPECTION RE-0-11.11 I Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge L6 Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION 771-0220 APPLICATION APPROVAL This application Is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid, and .4acolpt is acknowledged In apace provided. OF ' IGNATU DATE q1 RELEAS-E(rBY ATTENTION Off 1 3 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 ITFOM� I t �V� I r 1; ATE RECEIV`�, CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWAM.MMEINAME OF BUSINESS ,Tessie- MAILING ADDRESS 52'.0 Lr') CITY ZIP ELEPHONE Ljr'1011j'-> cno�'02 776-49'1-1 NAME L Cwt I Ic n ADDRESS t AVC 5E: CITY zip ELEPHONE 9q2.C)S22S 1-79-SIP NAME cek# I L)i�i fe. - ADDRESS k I q 7 '2 )jj 6 ir ZIP TELEPHOF4E NUMBER EtRATION DAT9* ��45 no 4412A 1 -qj1 o/b q ACCOUNT PARCEL NO, [j NEW RESIDENTIAL [:] ADDITION COMMERCIAL rj REMODEL MULTIFAMILY REPAIR GRADING CYOS DEMOLISH TANK 0 GARAGE CARPORT RETAINING WALL ROCKERY (TYPFTIF UPE. BUSIVESS OR W§M'V) FtPLAIN:, NUMBER j I NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE R&DIadria oil �f "A I -00570"_ �Ardff.2WAT, "AM In PLUMBING / MECH COMPLIANCE OR CHANGE OF USE SIGN n FENCE ( _ FT) 0 OTHER FIRE SPRINKLER FIRE ALARM CRITICAL AREAS NUMBER ,to 15 PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB sulTEIAPT# �DDRESS 5�,(D SearloIP"6 Lvi PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APPMV*d AW Peffrij 116quired street ute Perrnft AWd EXISTING - PROPOSED inspecdon neqdred Bidm$* Requir6d REQUIRED DEDICATION- FT Undarwound VjWgroqulrad METER SIZE LINE SIZE I I NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 REMARKS ENGINEERING REVIEWED BY-= ffvWW=§ 11MW, DATE FIRE REVIEWED BY DATE VARIANCE on cu; SHORELINEORADB# I INSPECTION 1$ BOND REO'D POSTED 13YEs 13NO z I SEPA REVIEW SIGN AR HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , , LOT COVERAGE I REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFISIDE REAR I - 152 I PARKING k _LP LANNING REVIEWED BY DATE 1 06 REQ`D ff-MVIUtu ____r on ruej-Durning egg spum UMC 81S.1.7 COD OCCUPANT CHEO KED BY TYPE 0 CONSTRUCTION E C OK2 )1V)40—-_,1'D ff2— GROUP S SPECIAL INSPECn 9 [AREA OCCUPA P CI I R C I LOAD EQUIRED 171 YES 3U M FREMARKS P 0 1 PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD A-1611 0 L—W :P1 pa� Description FEE Deacription FEE I Plan Check State Surcharge HEAT SOURCE % 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 h BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBILIC Grading X URSS, SIDEWALKS. DRIVLVAYS, MARQUEES, ETC.) WILL. REQUIRE :3 DONN" (C SEPARATE PERMISSION. t: Engr. Review I PEnUITAPPLICATION: IGO DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMrT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. -ASSIGNS AND 6uCC ESORS"' Fire Fl&46W Plan Chk. Deposit I IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire ln�peption 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 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapInsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - iOgVAL Recording Fee Recelpf N I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICA 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 appikatIon is not a permit until signed by tho TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 4ocolpt Is acknowlediaed In space provided. WORKMEWS COMPENSATION INSURA14CE AND RCW 18.27. I DATE ED (425) OFVW 'PG�t' MRELEASEDFBY 91 771-0220 DATV ATT1ENTION M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIi,, A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW-INSPECTOFk CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 GREEN - ACCOUNTING PRESS HARD -YOU ARE MAKING 5 COPIES k z 0 0 M M C M 0 r IT! 10 C 0 _n M M Fn z 0 M