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20030798.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OMER NA OF BUSI SS 6f Lal e_-L MAILING ADDRESS Ck.0 U Y - _/ 1�7rltA'1' C NAME 7DDRt§S V 7 R 0 FlITY C **_ j__<_ - F_ : ek A 1r'J NAME "A - ADDRESS &1/2)2M CITY STATE LICENSE NUMBER ZIP ITELEPHONE TELE ZIP I TELEPHONE NO. a 12 CBL N PERMIT EXPIRES USE PERMIT ZONE N U M B E R JOB ADDRESS PLAT NAMEISUBDIViSION NO. LOT NO. L D NO. LID FEE$ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP ApDroved 13 RW Parmit'Required tj Street Use Permit Rsqd 13 EXISTING — PROPOSED Inspection Required 8 Sidewalk Required REQUIRED DEDICATION— FT Underground Widng required 13 METER SIZE LINE SIZE _[ NO. OF FIXTURES PRV REQUIRED YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE DATE FIRE REVIEWED BY DATE 1,10 M VARIANCE OR COU I HORELINEORADB# INSPECTION 1$ BOND DATE CHECKED BY REO'D POSTED 1E3YEs ONO SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT I ALLOWED . PROPOSED I ALLOWED , PROPOSED NEW 1�1 RESIDENTIAL PLUMBING I MECH LOT COVERAGE I ALLOWED PROPOSED REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) FRONT SIDE REAR FRONT URSIDE REAR COMPLIANCE OR ADDITION COMMERCIAL 0 CHANGE OF USE REMODEL MULTIFAMILY 0 SIGN 13 FCK1NG_____'I­1 REaD "N*O AH E Of Wh ther the water Syste�DA N�gt�herth�ewate�r FENCE REPAIR 0 GRADING CYDS 0 ( — X_ Is 11 6. open -11- M Ision tanks are DEMOLISH 1:1 TANK OTHER City Code. tankS per EM".30 020 L GARAGE RETAININGWALL 0 F RE SPRINKLER CARPORT 0 ROCKERY FIRE ALARM W (TYPE OF USE. BUSINES A ACTIVITY) EXPLAIN. Z CHECKED BY OCCUP E ZZ2!� ITYpf=UCTION GROUPP - NUMBER NUMBER OF RITICAL OF DWELLING AREAS CUMBER it) / I I k OCCUPANT SPECIAL INSPECTION AREA LOAD —STORIES UNITS REQUIRED [:] YES DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECnO:3S PER UBC 108/FINAL INSPECTION RE0'D C' e. J Ile ai D'I.00, Raw VALUATION $ 02 Descriptlon FEE Description FEE Plan Check 7"173 State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK 140: VESTED DATE Plumbing M2 6 Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t__ HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading 2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE :3 SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION: 180DAYS 06. PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt # FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due -7 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 0, NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- X1 Recording Fee Receipt # 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 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 AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO Building Official or his/her Deputy: and Face are paid, and FOR INSPECTION receipt Is acknowledged In space provided. IT WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE SIGM R AGE1 DATE SIGNED (425) !3— N —0 ZA e0t "Aj 7 -0220 71 --o/1010 RE�I?�D BY DfTE ATTENTION M 1333 11Y4, A,� ZA hay, Q091 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL f "A 4 VZ 41, A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW. INSPECTOW CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING BENZ] m is RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION IER NAME/NAME OF BUSINESS N r I I MAILING ADDRESS 7 fa !I CITY ZIP rrILAA C,- j NAME I C ADDRt1§S CITY , 8 C��a (a J _g NAME CA 4/-.& ADDRESS CITY STATE LICENSE NUMBER PROPERTY TAX ACCOUN 276'f la:WW ADDITION REMODEL 0 REPAIR DEMOLISH 0 GARAGE CARPORT MPE OF USE, I NUMBER OF STORIES DESCRIBE W0`R HEAT SOURCE PLAN CHECK I ....... ... .... .. 2'�j I N PERMIT EXPIRES USE PERMIT "'E NUMBER2�&J-6 7!Z JOB ITE/APT# SS ADDRE /Z±/ 57 PLAT NAME/SUBDIViSION NO. LOT NO. LID NO. LID FEE S TESCP APP(cried PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Aw Permit Required Stroal Use Permh Wd EXISTING — PROPOSED Inspection Required Sidwatic Required REQUIRED DEDICATION— FT Underground Wiring required METER SIZE LINE SIZE I NO. OF FIXTURES PAV REQUIRED YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE P-111:0 0113C xCeir milloy nil zq-�-rqo U VCU UT GUT INMUMN Aftj CBL # AffflW KL NOT ENGINEERING REVIEWED By BE ACCEPTED DATE FIRE REVIEWED BY DATE ZIP TELEPHONE VAMRIANCE OR SHORELINE OR ADB# INSPECTION BOND EXPIRATION DATE CHECKED BY I REQ'D POSTED 10YEs 1$ 13NO SEPA REVIEW SIGN AREA HEIGHT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED I I , EXP — RESIDENTIAL PLUMBING / MECH LOT COVERAGE LOWED REQUIRED SETBACKS (PT) PROPOSED SETBACKS (Fr.) FRONT SIDE REAR FRONT LIR SIDE REAR AL PROPOSED COMPLIANCE OR COMMERCIAL 0 CHANGE OF USE z -.45 MULTIFAMILY— SIGN REQ`I GRADING cyos-4.4 FENCE x FT) REM; %�51 OTHER TANK b 3 RETAININOWALL FIRE'SPRINKLER ROCKERY FIRE ALARM k -MA MINE a U - - - - - - - - - - - - - - - - - - - ATE - 0. IES OR ACTIVI[TY) EXPLAIN: 0001 'r CHECKED BY ITY=UCTION I coa OCCUPAV, 7-M Z ' 67—f GROUP,6:--.":? NUMBER OF CRITICAL 117 � - DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT UNITS NUMBER REQUIRE 171 LOAD BE DONE GLAZING % LOT SLOPE % VESTED DATE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D VALUAT19,.V $ Descriptlon F�7 Plan Check Building Permit Plumbing Aftinswom. __ I is FEE Description State Surcharge City Surcharge 1I A_00 -- FEE Lo!) —_ 7770F_6K .7) __[ Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO 1: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading I 2 3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY NOT BE FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PRCfVIS!ON.. Recording Fee 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 THE OWNER.1- I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL - This application 13 not a permit Until signed by the TION; AND IN DOING THE IZED THEREBY, NO PERSON WILL BE EMPLOYED WO R IN VIOLATION OF THE LASOt=DE00F THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Buflding Otfl" or hlsfhw Deputy: and Foos are paid, and receipt Is acknowledged In space provided. I WORKMEN'S COMPENSATION I URANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE (ME R AGE A, I V DATE SIGNED lAq'L-% rVA-01 771-0220 REKAWD BY D�TE ArmNTION PING M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUIL O%RUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE -AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPEETOR' CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSES60A 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING'. t z 0 m C m -A C.) 0 C m m 10 C 2 0 -n m m 0 m C W C C11) M 0, z z 0 m