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20030807.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER! NAMEINAME OF BUSINESS MAILING ADDRESS _V q 4e- 'd 2�3I LLn 1-% ��A A CITY ZIP I TELEPHONE -FANLMAS q9W)HIS-02-111, NAME ZIP I TELEPHONE LICENSE NUMBER EXPIRATION DATE ) Lci�c_a 1 !?2� P 11-0-6 rTY TAX ACCOUNT PARCEL NO. 1] m 0 NEW RESIDENTIAL X PLUMBING 16) 0 ADDITION 0 COMMERCIAL 0 COMPLIANCE OR CHANGE OF USE REMODEL 0 APARTMENT 0 SIGN REPAIR 0 GRADING CYDS 0 FENCE ( _X_Fr) 0 DEMOLISH 0 TANK 0 OTHER 0 GARAGE o RETAINING WALL 0 RENEWAL CARPORT ROCKERY OWE OF USE, BUSINESS OR ACTIVTM EXPLAIN: NUMBER NUMBER OF CRITICAL OF DWELLING AREAS _.ETORIES UNITS NUMBER DESCRIBE WORK TO BE DONE ft 008"A W101"s '-I' ). - 1, 1 � USE ZONE JOB ADDRESS ;2 2 D _�3L�f j PERMIT EXPIRES PERMIT NUMBERC�& PLAT NAME/SUBDIVISION NO, LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IESCP APP': RW Permit R-:.,II- Street Use Penn 'eq d EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT undertiround' Wiring required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 z REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ST BE ENGINEERING FIRE REVIEWED BY DATE ul cc VARIANCE OR CU SHORELINE OR ADS# INSPECTION I PBOND REO'D OSTED 13 YES [3 NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT I ALLOWED . PROPOSED ALLOWED . PROPOSED LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR I re PARKING LOT AREA I PLANNING REVIEWED BY DATE REO'D I PROVIDED I I CHECKED BY ITYPE 11ON478TIlu CP9F_—L OCCUPANT &t .7 GROUP V-2) SPECIAL INSPECTOR jAfiEA OCCUPANT REQUIRED 0 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'D required on fuel-bus-ning appliances in i unhmted space& UMC 815.1.7 as Description7 FEE Description FEE U Plan Check HEAT SOURCE GLAZING % LOT SLOPE % Building D it DI I'VA Yz, -iz.-a PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PFLIVATIE PROPEM ONLZ ANY CONSTRUCTION ON THE PUBUC Grading Recording Fee DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. Engr. Review City Surcharge I "s PERMIT APPILICATION: 180DAYS I PERMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS Engr. Inspection State Surcharge SEE BACK OF PINK PERMIT FOR MORE INFORMATION ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Deposit I'APPLICANT. IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS, WASHINGTON, ITS OFFICIA&S. EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 45� FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amo�unt Due 5 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 1 2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Landscapelnspi, Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL N is CORRE"' 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 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 receipt Is acknowledged in space provided. WORKMENS COMPENSATION INSURANCE AND RCW 18.27. SIGNAT RE DATE f- I &IGNATURE (OWNER DAt: SIGNED t425) AOFALS /006�/� �M-lk 771-0220 wopm� FL A 'y DATV' ATTENTION Off 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW -INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER - GOLD -ASSESSOR 10/011 I ..O< ., 4 .. - A ll� m Is 0" RECEIVED ., , j, CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION KR NAMENAME OF BUSINESS , , a "LING ADDRESS A,4e- CITY ZIP TELEPHONE ADDRESS ZIP ITELEPHONE. 7 r),rrne_ P�n e. reA (A ��o <�, . USE ZONE JOB ADDRESS 2-:`642D PERMIT EXPIRES PERMIT NIJIMBER4em PLAT NAME/SUSDIVISION NO. LOT NO. LID NO. LID FEE $ TEScr APPIOV PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pemilt RaWlrod Suw Use PUMN RWN EXISTING — PROPOSED Impecuon R&qWrsd Sidmalk Raqum REQUIRED DEDICATION— FT UndKWOUnd w1moraqw-1 13 METER SIZE LINE SIZTJ�, OF�FIXTURES PRV REQUIRED I YES 13 NO E3 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROMRAINAGE GAS, f I , d" I "IA -MUST, BE! ENGINEERING . . ..... . . EBB FIRE REVIEWED BY DATE zip TEIIPHONE F" ZOT 0 VARANCE OR CU SHORELINE OR ADI3# INSPECTION SON LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POS ED O�QZS L2_ E3YES [3NO .2 $EPA REVIEW SIGN AREA HEIGHT TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPPT -5-7, 2 , a EXP [3 NEW E3ADDITION REMODEL REPAIR .9410OUSH .13"'t' - ekiAGE O'CARPORT OF JK RESIDENTIAL X PLUMBING 16> LOT COVERAGE ' ALLOWED PROPOSED I REQUIRED SETBACKS (FE) FRONT SIDE REAR 0901`060SETBACKS (Fr) FRONT LIRSIDE REAR 0 COMMERCIAL o COMPLIANCE OR CHANGE OF USE PARKING LOT AREA PLANNING REYIEWED BY ---' DATE u APARTMENT U SIGN REO'D PROVIDED [3 GRADING CYOS [3 FENCE X FT) REMARKS TANK OTHER 1:3 J11 RETAINING WALL 0 o ROCKERY RENEWAL CHECKED BY OF CONSTRUCTION JdODE OCCUPANT ITYPE I GROUP. NUMBER OF DWELLING Z CRITICAL AREAS S PECIAL INSPECTOR AREA OCCUPANT UNITS NUMBER- IVI ,I+ REQUIRED [3yES LOAD TO BE DONE d C8 REMARKS RECVD '-J'�+&*Vf fiAd Z=::::: 1�pe B or L vent connectors 1 0 VALLIATION $ Descirlptlon FEE Description E E ,� I- 2! - W L/ Plan Check nulv HEAT SOURCE GLAZING % LOT SLOPE % Building 0 Q1 Iflo yz PLAN CHECK NO: VESTED DATE Plumblng� Mechanical q '20 D( 'TW5 pMrr AUTHORIZES ONLY IM WORK NOTFD. THIS PERMIT COVERS WORK TO towayRucTion Puauc --x� - 2_ —7. . BE DOME ONPRNATE PROPERTO ONLY. ANY ON Tm :;DOMMN (CURMSIDOWAMVRMWAYCOARGUEES.M.)'WILI:REQUIRE' Gradipg Recordingfee SEPARATE PEMSSIOIL Engr. Review City Surcharge Its -d PERMITAPPILICATION: 1100DAYS PERMIT LIMM I YEAR - PROVIDED WORK 19 STARTED WITHIN 160 DAYS Engr. Inspection State Surcharge SEE BACK OF PIW PEMIT FOR MOREINFORMIATION Aj,0N BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS�AND SUCUSORi Traffic Mitigation Plan Chk Deposit ;A Np= RE . AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFiCIALS1. EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt # ALL CLAIMS FOR DAMAGES Or WHATEVER NATURE,AR1SINGDtREC7VYOR INDIRECTLY FRO14 THE ISSUANCE,OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amount Due 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.' Landscapainap.., Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL I GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMIPIY WITH CITY AND STATE LMVS REGULATING CONSTRUC- CALL TWs application Is not a permit until signed by tho 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 FOR INSPECTIONI Building OMcIW or hWftr Deputy: and Fm are paid. and receipt to acknowledged In space Provided. WORKMENS COMPENSATION INSURANCE AND RCYV 18.27. AGE DAt SIJED I- OFFIP)ALS SIGNAT RE DATE SIGNATURE (OWNER L72L 1425) 'RELEASED L9 j5l�, �jk bd 771-0220 BY DATLf ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 71.n991 .. I A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FM PINK -OWNER - GOLD -ASSESSOR 10101 Fj z 9 0 M M C: ME 40 0 C: -1 r. x PH M 0 �z 01 0 0 C: Ca z 9 0 M