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20030777.pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS a - V- - MAILING ADDRESS -3 "N v4f <If CITY ZIP TELEPHONE 9,t>/%A0/VD-5> 142,5, -71-4-4b-719 NAME ADDRESS CITY ZIP -----[TELEPHONE NAME tj jCBL# A DDRESS ,44-15; IqVj CITY ZIP TELEPHONE g w-f 01 01 1 STATE LICENSE NUMBER EXPIRATION OAT 0 1,,s o tJ f A( pj�) 4 9 + PROPERTY TAX ACCOU PARCE70 0 0 t 0 0 +900 ? ;�- 0 -,7,- OPINION 0 NEW XL RESIDENTIAL A PLUMBINGIMECH COMMERCIAL COMPLIANCE OR 0 ADDITION 0 0 CHANGE OF USE 0 REMODEL 0 MULTIFAMILY 0 SIGN 0 GRADING o FENCE X 0 REPAIR CYDS ( _ _ FT) 0 DEMOLISH 0 TANK 0 OTHER GARAGE ri RETAINING WALL FIRE SPRINKLER � 11 .� 017111.14rRY 0 FIRE ALARM (TYPE OF USE, BUSP"S OR ACTIV",,E�PLAI.N: , A I PERMIT EXPIRES USE PERMIT ZONE NUMBER-��g JOB ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IESCP Approved RW Perinit Required Street Use Permit Req'd EXISTING - PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION- FT Underground Wiring required METER SIZE LINE SIZE I I NO. OF FIXTURES PRV REQUIRED YES [3 NO C3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE BE ACCEPTED FIRE REVIEWED BY 43 z DATE Lu cc rL. ��f �Iftw .;4 BOND VARIANCE OR CU A WATM S POSTED SEPA REVIEW CPROPOSED COMPLETE EXE A& I EXP - LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR 0 3 z PAFIKING LOT AREA PLANNING REVIEWED BY DATE REQ'D I_ER9Y_1oED1__ CHECKED BY GROUP N MBER OF j NUMBER OF DWELLING CRITICAL AREAS NUMBER SPECIAL INSPECTION REQUIRED AREA OCCUPANT LOAD STORIE��A UNITS DESCRIBE WORK TO BE DONE REMARKS I PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D 9 v1, A 915W AIA-rvg--4 H, PURSUANT TO ECDC 19.30.020 a &As rva-4AcjE' A/.4-r%/ #-A L,- � —APRMURERECU (PRV) Al! � BE INSIAT I IRP NEAR Qz& S Pj V, -z V, VALUATION THE WATER SHUTOFF 1 $ HEAT SOURCE I GLAZFNG—% — * I LOT SLOPE % PLAN CHECK NO: I VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOUAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS 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 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 ORDINANCE 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 TIIE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATIOMTHE LABqB_CODfOF THE STATE OF WASHINGTON RELATING TO '154ND RCW 18.27. qAMdfflNSURANL DATE SIGNED In - t,4 - 0 Description FEE Description FEE Man Check State Surcharge Building Permit a City Surcharge — Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # 1::_— Landscapelnsp. Total Amt. Due Aq.-- Recording-Fee R ceipt N ___j APPLICATION APPROVAL CALL This application is not a permit until signed by the Building officlat or his/her Deputy: and Fees are paid, and FOR INSPECTION /'�e2elpl, Is acknowledged in space provided. 0 F I ; W� U DATE (425) MIS; 771-0220 11DATV RELEASED cv*r -1 QQ , _:�� ATTq"TION 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 4 DATE RECEIVEJ CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION ,0DATE REC OIWIER�71E/NAME OF BUSINESS (?-A MAILING ADDRESS A V,�- CITY TELEPHONE Zip 42,59; -71 1�1 19 NAME ADDRESS fA /jk CITY W ZIP NAME JCILN ADDRESS AJ05 L-POI-Y CITY ZIP TELEPHONE 9 CA f1f V�_ q t� I �,O(p - -70�"55i STATE LICENSE NUMBER EXPIRATION DATE P it) 4 OIC 2,po 4 4 4 9.,j. 05M PROPERTY TAX ACCOUNT PARCEL4 0 C) -A- 19 0 0.4 eii (ba ig C) NEW ZL RESIDENTIAL PLUMBING I MECH COMPLIANCE OR 0 ADDITION COMMERCIAL CHANGE OF USE REMODEL MULTIFAMILY SIGN GRADING FENCE REPAIR CYDS X Fr) 0 DEMOLISH 1:1 TANK OTHER [3 GARAGE RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM F: (TYPE OF USE, BUSINE36GR ACTIVITY) EXPLAIN: PERMIT EXPIRES 2,f2— I .., 11 USE PERMIT ZONE NUMBE - tl�;7 7 2 V JOB SUITE/ # ADDRESS,,,,�/ PLAT NAMEISUBDIVISION N017] LOT NO. LID NO. LID FEE S TESCP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerrM Required Street Use Permit Rsq'd EXISTING — PROPOSED IrApectlon Required Sidewalk Required REQUIRED DEDICATION— FT Underipround Wking required 13 METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 REMARKS OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE GAS PIPE TEST MUST BE ENGINEERING REVIEWED BY Ut AtXtri LU DATE FIRE REVIEWED BY DATE W W PURSUANT TO UPC 605.2 VARIANCE OR CU S&&EEnj:t4_ "Ili! r ND 7 V-10IN POSTED LWASITEITIM %M *4VR A SEPA REVIEW MAR SIGN AREA wor, ! COMPLETE . EXEMPT I ALLOWED . PROPOSED ALLOWED , PROPOSED LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR LOT AREA I PLANNING REVIEWED BY REO` or L vr!t connectors CHECKED BY ON coub V%A;UrArf 1 GROUP " 192 NUMBER NUMBER OF CRITICAL 4.,t DWELLING A EAS SPECIAL INSPECTI FREA OCCUPANT OF RI LOAD STO E�A I UNITS NuMBER REQUIRED — YES DESCRIBE WORK TO BE DONE REMARKS i4s;rAvL- A A/j5 vA A/Al -LIP-AL, PROGRESS INSPECTIONS PER UBC I GOMINAL INSPECTION REO'D ---- PlIESUANT TO ECDC 19,30,020 APRESSIMREGULATORVALVE(PRV) QKA S Fl-i, 0 1A tJ V, 4740,".47/J�5 VALUATION I bnAJL.L# J311 JL1'4Yf_ALLr.IlJ INJUP.K! IA2677 $ ;Description FEE Description FEE 7 /1_wt Van Check State Surcharge HEAT SOURCE GLAZING %i LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical A THIS PERMIT AUTHORRES OMY THE WORK NOTED. THIS PERMIT COVERS WORK TO h BE DOME ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUBUC :1 Grading r 3 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE IPE SEPARATE PERMISSION. a Engr. Review PERmrTAPPucAtiom: isoDAYs PERUIT UIAM I YEAR - PROVIDED WORK IS 8711ARTED WITHIN 180 DAYS Engr. Inspection SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION I '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 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 Landscapainsp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GWEN IS CORRECr 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 AUDIORIZED THEREBY, NO PERSON WILL BE EMPLOYED' BuIldin OM W or hlsfher Deputy: and Foes are paid, and IN VIOLATION,101� THE LABgJLZ00E_0F THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 7-c-c Ipt Is acknowledged In space provided. WORKMEPCS ,�COA�f�� INSURANCE,4,ND RCW 18.27. OF C SIGN U DATE SIGNATUR fp&,ER ENT)) ATE SIGNED 1425) WA" 11�11_,2 A 1 0 0 Kz— - -/ = — 771-0220 RELEASE NY' "DATOr ATTE TION Off 1333 IT IS NLAWFUL 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 L z 9 0 M =i:% 5i � a M C M 10 M 10 F; z 0 M M 8 V5 0 Fn C2 C M 0. z 0 0 M