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20030767.pdfL ECEIVED �001 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS if ii-K—i oc- Eb kutkps MAILING ADDRESS '�) \\c> -ZA%3,L— CITY ZIP ELEPHONE Y) IiAME ADDRESS CITY ZIP ITELEPHONE NAME ICBL# ADDRESS CITY ZIP I TELEPHONE STATE LICENSE NUMBER PARCEL PERMI EXPIRES USE rr_nmi 1 A ZONE �_p &,6-eMXZ NUMBEP��q — JOB suiTEIAPT# ADDRESS 2�9 Aur- -5, pLAT NAME/SUBDIVISION NO. T NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Ap=ed RW Pefrn" Sjfeqt Use perynh Raq'd EXISTING PROPOSED inspectio Required n Sid6w&lk Raqulfdd REQUIRED DEDICATION— Fr UndeWmr4 WiringfequirOd 13 METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED YESO NO 13 REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDR�AINAGE I REVIEWED BY DATE ATE FIRE REVIEWtT"e B or L vent connectsrs VARIANCE P�iiil) BY CHECKED !I OYE 0 lull. SEPA REVIEW SIGN AREA COMPLETE . EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED C H NEW RESIDENTIAL PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR IA COMPLIANCE OR R COMMERCIAL 13 S E DiDr.-TUr z oil I E —DATE- ADDITION CHANGE OF USE TARM —1 PUWWNU 010 REMODEL MULnFAMILy [3 SIGN PA KING 0 REOD I PIRO RVED QY CITY INSPECTOR GRADING [3 FENCE Fr) REPAIR CYDS I X Fr) REMARKS AFFIDAVIIS S EL Rol DEMOLISH TANK OTHER EPIED F RE SPRINKLER E:iGARAGE [3 RETAININGWALL FIRE ALARM �ER CARPORT ROCKERY (TYPE OF USE, BUSINESS OR ACTPATY) EXPLAJN: j )0 CHECKED BY ITYPE OF CON$IRUCTION CQPE OCCUPANT GROUP UMBER NUMBER N OF V OF DWELLING :24 SPECIAL INSPECTION AREA OCCUPANT 7 LOAD _LTORIES UNITS REQUIRED [3 YES DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER u0C JoefFINAL INSPECTION REGID as jj arj L VALUATION $ Description FEE Description FEE Plan Check State Surcharge EAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge .5 VESTED DATE PLAN CHECK NO: Plumbing d Mechanical THIS PERMrr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I= BE DONE ON PRIVATE PnOPEFM ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC-) WILL REQUIRE 3 t: SEPARATE PERMISSION. Engr. Review PERMIT APPUCATION: 100 DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARMD WITHIN 150 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, 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 OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # a EDMONDS. WASHINGTON, ITS CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY IALL FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT S14ALL NOT BE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due 9 0 DEEMED TO MODIFY, WAIVE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Recording Fee Receipt # zi I HEREBY 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 I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the CALL Building Official or hisitier Deputy: and Fees are paid. and THE OWNER. TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. IN VIOLATION WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27. 0 CIA IG�rrEr DATE SIGNATURE (OWNERQjlrAGI�N� DAT SIGNED IA95) 771-0220 BY ATE __ RELTSED off 1333 AA f/w /A/j /A 6-/,v ATIthIWN q 1,— " Ir TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL tri Ua 9 IT IS UNLAWFUL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPjCTjR A FINAL CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR GREEN - ACCOUNTING HARD -YOU ARE MAKING 5 COPIES 04/02 PRESS z 0 q 0 M :i TH M C M 0 C M C _z _n M M —In C z z 0 0 M j?l, � - F', 7! 4 �",Th �SSSg. . � r. Pfolkif p 17 f% .1 1, 1 IV I -' 1-,"7 1 renS 7"W7,17, 77 4 .1, .%. ,"pfiff' .,0, '1,' . , if 1, 1,4 TIONS RECORD OF INSPEC 4 If I I INSPECTOR DATE APPROVED SETBACKS f45 FOUNDATIONS Footing I k e t %plef t a a SL if 11.4 .. . . L I L 1. : 4 : I I If - Pier/Porch if - 1. 1 1 11 L qv%r" 4. M I A L 41.1 k .1 1 f Retaining Wall pf ff I k NOSS @gSS& dwell Slab.insulation f I k .1, L p d f 1 4. OL L 1 4 1 f.. I . P%,' f PLUMBING d y j r.. k I f� I I C 4 1 1 L I d m Underground 13 Ul.DATE RECEIVE6 '7% 7"s" CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS (f 11-IZ-1 OE Ebmot-40S MAILING ADDRESS 7) wz> 6.0. CITY ZIP TELEPHONE NAME ADDRESS CITY ZIP ITELEPHONE NAME ICBL# ADDRESS CITY B.0 N N 11111, WAR560 CU_ STATEILICENSE NUMBER EXPIRATION DATE [ CHECKED BY NO. 0 NEW 0 RESIDENTIAL. 0 ADDITION COMMERCIAL 0 REMODEL 0 muLnFAmd REPAIR 0 GRADING CYDS DEMOLISH 0 TANK GARAGE CARPORT RETAININGWALL 1:1 ROCKERY (ME OF USE. BUSINESS OR ACTIVITY) EXPLAIN: %:%�3ko NUMBER NUMBER OF OF R!E�LING .STORIES DESCRIBE WORK TO BE DONE e,, d -z /7 a a?PA li"it'JA a Az z: PLUMBING / MECH COMPLIANCE OR CHANGE OF USE SIGN FENCE x FT) OTHER SPRINKLER oFIRE F RE ALARM tzAi PERMIT EXPIRES = / " , M1114w, 1 1 USE PERMIT ZONE NUMBER-_;�&,j�-i!07g�7 JOB SUTrE/APT# ADDRESS Auc- 0, PLAT NAME/SUBDIVISION N 77. LID NO. LID FEE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appr0v*d RW PerrNt Required Street Use Permit Wd EXISTING - PROPOSED InspectJon Required 13 S awalk Required REQUIRED DEDICATION- Fr U=d Wiring required METER SIZE LINE SIZE NO. OF IXTURES PRV REQUIRED YES13 NO 13 ?5 0 REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE I ENGINEER 4QWWyor L vent ConneetodATE .� - M��Illllft � FIRE REV SpaM& UMC 815.1.11TE Lu ElAyeated W rL VARIANCE OR CU SHORELINE ORADB11 I INSPECTION BOND REO'D POSTED OYES 13NO 1$ SEPA REVIEW SIGN AREA HEIGHT COMPLETE - EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED� LOT COVERAGE REQUIRED SETBACKS (Fr.) I PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT I Slog REA FRONT L/RSIDE REAR PARKING LOT AREA PLANNING REVIEWED BY DATE IL REO`D PROVIDED ft I RAS P]Pi TEST IMAUSTI BE CHECKED BY ITYPE OF CONURVICTICN CQDE — OCCUPANT CRITICAL 7VI GROUP -a / 5 V AREAS 8PECtAL INSPECTION JAREA OCCUPANT NUMBER REQUIRED 0 LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REGtD. 2S n, C_ 11-4L :1&1, A&Y.- 2anraz- n3-=_x2 ciiec 0 HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PEWFT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSMUCTION ON THE PUBUC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPILICATIO It ISO DAYS PERMIT umm I YEAR - PROVIDED WORK 18 STARTED WITHIN ISO DAYS SEE vACK OF PINK FERMAT 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 #.GERTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSILLANCE 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 CITY$ ABILrrYT0 ENFORCE ANY ORDINANCE PROVISION.' I HEREBY ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRE" AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE To COMPLY W" 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 WORKMENS COMPENSATION INSURANCE AND RCW 18.27. _ SQ11 SIGNATURE (OWNE" GENT DATE SIGNED /11?1 1-d' tml - 6­1 1 /0 — / — o $ F -, Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge &2 Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapeinsp. Tatal Amt. Due Recording Fee Receipt # �-_ n� CALL FOR INSPECTION (425) 771-0220 EXT 1333 APPLICATION APPROVAL This application is not a permit until signed by the Building OfficW or his/her Deputy: and Fees are paid, and receipt Is acknowladged,in iipace provided. 0!:FM4CIAIG q DATE T" EL ED BY)V f J1D%R 714M Al A "I AA I'Al. Jyf - 1 S4 4ILl- it IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL (14jr_jLy1gW A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW-INSPICT R CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSESdl 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING NEED z 0 IT! M M 0 —40 0 C: E�c M M IC) �5 9z CO) 0 -n -n � IT! 11711 0 o Fn 0 X z CO) z 0 1 0 M