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20030760.pdfI DATE RECEIVED ,5CKL16 0 Pue CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OAR NAMEINAME OF BUSINESS a(hoe- MAILING ADDRESS CITY ZIP TELEPHONE C--/\- -7 -7 1 _5'I &Lrt,,<�nc f�u; jo NAME ESS CITY ZIP ITELEPHONE 0 PERMIT EXPIRES USE PERMIT ZONE NUMBER DQ"'- J013 �D - PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW Permit Required Street Use Permit RWd EXISTING — PROPOSED— Inspection ReqLAred Sidewalk Required REQUIRED DEDICATION— FT I Underorotmd r r equir METER SIZE LINE SIZE NO. OF FIXT� REQUIRED NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 43 z NAME C'n CBL 0 I Ice ENGINEERING REVIEWED BY DATE ADDRESS ��711? :�W &,� 6 M) FIRE REVIEWED BY DATE W cc CITY I TELEPHONE ZIP VARIANCE OR Cull I SHORELINE OR ADB11 'o INSPECTION REQ-13 �0 MYES gNO BOND POSTED STATE LICENSE NUMBER r IV, §TE leus-sEsc000zps I/ CH CKED rJ3 SEPA REVIEW COMPLETE , EX :7 EXP SIGN AREA I ALLOWED PROPOSE11 5 �A '1 HEIGHT ALLIWE� , PROP OSED 2_� 9 5 PROPERTY TAX ACCOUNT PARCEL NO. C.;Ls 4-61 &o 10 �- - NEW RESIDENTIAL PLUMBING/MECH 0 COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE REMODEL MULnFAMILY SIGN REPAIR GRADING o FENCE CYDS X FT) LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (Fr.) FRONT SIDE REAR PROPOSED SETBACKS (Fr.) FRONT LJRSIDE REAR z 06 PARKING REOD PROVIDED LOT AREA PLANNING REVIEWED BY DATg AP REMARKS DEMOLISH TANK o OTHER R 0 GARAGE o RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACTMM EXPLAIN: 62,ic—_ CHECKED BY TYPnCANSTRkjCTION N 77 OCCUPANT GROUP NUMBER OF STORIES NUMbER OF DWELLING CREAS RITICAL .4. UMBER SPECIAL INSPECTION JAREA REQUIRED 13YES -OCCUPANT LOAD DESCRIBE wonk To BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 110111MINAL INSPECTION REG _jC I(C) see- VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT, SLOPE % Building Permit lool City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AMORRES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE t: SEPARATE PERMISSION. 2 5 PERMIT APPLICATION: 180DAYS Grading Engr. Review IL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit 71r? IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF a EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND IFire ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY Inspection Receipt # FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due 21 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # I HERE13Y 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 APPLICATION APPROVAL This applicaUon Is not a permit until signed by the CALL Building Official or his/her Deputy: and Fees are paid, and FOR INSPECTION receipt Is acknowledged In space pSovided. WORKMEN'S COMPENSAJ4MNRURANCE AND RCVV 18,27. SIGNATYRE (PINNER ORIGENTI/ DATE SIGNED (425) 771 -0'29C%J OMIALS S ATURE DATE/ 4 V5 RELEASED BY nAfE A"TT N ION EXT 1333 I is LA I T S I UL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I A FIN IN ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATEbCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE - YELLOW. INSPECTOR PINK -OWNER - GOLD -ASSESSOR 04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 4 0 M -n M M --I 0 M z 0 _n M M 0 CO) 0 0 Fn C V) ic Coll M 0; z 0 M RECORD OF INSPECTIONS p jk iL JDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION 0 R NAME/NAME OF BUSINESS ho r MAILING ADDRESS zip TELEPHONE 1�nQ (114 a�5-7`7 IS'l 1 NAME W 1A ADDRESS CITY ZIP ITELEPHONE NAME CBL # lice S �zw CITY ZIP ITEILEPHONE 7 q9r0 --77 STATLFLICENSE NUMBER e ZCSCOOO ll 'W 4- ATE a CH CK n BY] PROPERTY TAX ACCOUNT PARCEL NO. [3 NEW RESIDENTIAL PLUMBING/MECH ADDITION COMMERCIAL COMPLIANCE OR [3 CHANGE OF USE REMODEL [j MULTIFAMILY SIGN REPAIR \1 [:] GRADING FENCE CYDS, ( _ X_FT) \ I 0 DEMOLISH 0 TANK 0 OTHER 0 GARAGE RETAINING WALL FIRE SPRINKLER CARPORT._0-ROCKERY FIRE ALARM (TYPE 01�4SE, BUSINESS OR ACTIVITY) EXPLAIN: ER NUMBER OF OF DWELLING CRITICAL AREAS STORIES UNITS NUMBER DESCRIBE WORI(TO BE DONE k—aj c) -4o 6 ?) INIIte4 [PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB 'Sc—ro�Q P, v') P ADDRESS (63 0 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESGP Approved RW Pam* Required street Use Perm" RW EXISTING — PROPOSED irspection Required SW&watk Required REQUIRED DEDICATION— FT Undertiround Widing required METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED I I YES C3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE HEAT SOURCE GLAZING % LOT SLOPE % I ".. , I . I PLAN CHECK NO: VESTED DATE THIS PERunr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO k: BE DOME ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBLIC 3 S. ETC.) WILL REQUIRE 3 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEE 1: SEPARATE PERMISSION. PERMITAPPLICATION: 1180DAYS PERMIT UMM 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 C17Y 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 PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 21 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - I HF-RE13Y 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 WORKMEN'S COMPENSAVON-OWURANCE AND RCW 18.27. 1 1., DATE SIGNED ?� -- I -,?, — ENGINEERING REVIEWED FIRE REVIEWED BY DATE DATE a z us 11 lz VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND RE�'k 113YES POSTED_I jQ1 O�-- SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMP ALLOWED PROPOSEI) ALLOWElk PROPOSED 7 57-1;4 jp I iq /2.-/' , EXP 1 ;* LOT COVERAGE REQUIRED SETBACKS iFT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR I — z PARKING LOT AREA PLANNING REVIEWED BY DA REO'D I PROVIDED t— I - P �T I REMARKS i CHECKED BY NSTR ION C,7P OCCUrAf" jTYP_jC I GROUP SPECIAL INSPECT AREA OCCUPANT REQUIRED [:] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION RECtO VALUAnON $ 1 Description FEE Description FEE Plan Check 0 #**- State Surcharge Building Permit City Surcharge IS Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION (424).. 771-0220 EXT 1333 APPLICATION APPROVAL This application is not a permit until signed by the Building OMcW or hi0er Deputy: and Fees are paid, and receipt Is acknowledged Inspac�pSovided. OF IAL AT DATE/ S S" URE RELEASED BY WE IT IS *LA*UL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FIN4 INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR CATE 0T-,Q=UPANCY,HAS, BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING ME 0 n M rr, 0 -Cft 0 0 Fn C" X z :2 C& z 0 1 0 M