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20030829.pdfk, DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION 19R NAMERME OF -BUSINESS MAILINU AVURES TELEPHONE b7,1, 426- zip NAME ADDRESS CITY ZIP ITELEPHONE APDRESS CA tA A q, z,P TELEPHONE LICENSE NUMBER EXPIRATION DATE I L+2�0.p I t-j-1-oq TrY TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL ADDITION COMMERCIAL ��IMODEL APARTMENT REPAIR GRADING CYDS DEMOLISH 0 TANK [3 GARAGE CARPORT o RETAINING WALL ROCKERY M?9-OF USE, BUSINESS OR 4CTMM EXPLAIN: OF STO DESCRIBE NUMBER OF DWELLING UNITS BE DONE HEAT SOURCE GLAZING % PLAN CHECK NO: 'm ZONE PERMIT EXPIRES PERMIT n - JOB SUITE/APT# ADDRESse�_�2,// r all PLAT NAME/SUBDIVISIOk N7 LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCIP APPOVOCI AW Partrill Required Use Permit R*q'd EXISTING - PROPOSED inspection Requited Sidewalk Required REQUIRED DEDICATION- Fr urodargrour0d Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE REVIEWED/DATE FIRE REVIEWED BY DATE I I" VARIANCE OR CU SHORELINE OR ADD# INSPECTION I BOND REO'D POSTED 13 YES I SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROP08ED :XP A I LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFISIDE REAR /"c5j COMPLIANCE OR z CHANGE OF USE I I PARKING LOT AREA I PLANNING REVIEWED BY DATE 0 SIGN RECID I PROVIDED FENCE ( _ _ FT) REMARKS OTHER IJ RENEWAL CHECKED BY ITYPE POESON13 1 0 rTRUCTION C 1E — 01 CRITICAL q7 OR UP AREAS SPECIAL INSPECTISR AREA OCCUPANT NUMBER REQUIRED[j YES LOAD IREMARKS MOODS 1=19 n 1XVA Ul T)ilpe B or L vent connectors —LJ required *n fuel -burning appliances In VAILUATION $ Plan Check LOT SLOPE % Building VESTED DATE Plumbing Mechanical FEE I REO'D 1 9 I is 2� Wai i W THIS PERMIT AUTHORGMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONCE ANY COVOTRUCTION ON THE PUBLIC Grading Recording Fee DOMAIN (CURSS. SIDEWALKS, ORIVIEVAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review City Surcharge PERMITAPPLICATION: 180DAYS PERMIT UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr.inspection State Surcharge I SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Deposit IN INTEREST. AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS THE CITY OF WASHINGTON, OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Receipt # EDMONDS, ITS ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Review FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Inspection Total Amount Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Landscapelnsp. Receipt # ft� I IIERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION — APPLICATION —IWY 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 Building Official or his/her Deputy: and Foss are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Is acknowledged In space provided. WORKMENS COMPENSATION INSURANCE AND RCW 10.27. —receipt OF� IGNAJURE DATE 18XIGNATU�RF'L(OWNER DATE SIGNED 1A �01(AGE� 771-0220 —RELIFASE!CrGY A'I'TENTION Off 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL .0 771 221 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 10/01 OF z 0 0 M Ow. M 0 C: M M 2 rn M C 0 Irn- z 0) z M IP ATE RECEIVED PERMIT EXPIRES ti�zc7q I CITY OF EDMONDS USE ZONE PERMIT NUMBER CONSTRUCTION PERMIT APPLICATION JOB ADDRESS4� SUFMAPT# NAMEYNAME OF BUSINP6 VPLAT I NAME/SUBDIVISIO14 NO. LID NO. MAILING ADDRESS 12-524 V4 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP LID FEE S 7ESCP Appm"d RW Pam* Retpkod Street Use Pernik Roo EXISTING na^nnacn Inspec-d-R"Lirsd I I CLCPHONE Sidewalk RW.4*" 13 rA mmk, 0, "' REQUIRED DEDICATION— Fr I U to - t3t(o I WMg ubred 11 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13-1 A ADDRESS ROMANKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP Am Mkm mmm&. ITELEPHONE ITIA101 CTcn V1111- 661611f 61,exiaiA C_j r_kmc, 913 ENGINEERING REVIEWED/DATE ADDRESS z 1 FIRE REVIEWED BY DATE 0 Zlp;��UHON M rn VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND TE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED I � 13 YES [3 NO 42AP -1-T-04 ca SEPA REVIEW SIGN AREA HEIGHT In PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED ALLOWED PROPOSED PROPOSED 5 EXP M 10T COVERAGE REQUIKD SETBACKS (FT.) PROPOSED SETBACKS (Fr.) NEW RESIDENTIAL 13 PLUMBING I MECH ALLOWED PROPOSED FRONy SI R LIR SIDE REAR C M ADDMON [3 COMMERC [3 COMPLIANCE OR IAL CHANGE OF USE M PARKING LOT AREA PLANNING REVIEWED BY DATE \f34_ffiWODEL [3 APARTMENT [3 SIGN RECrD PROVIDED I E3 REPAIR [3 GRADING CYOS [j FENCE X FT) REMARKS Ej DiMoLjSH 0 TANK OTHER 0 .[3GARAGE RET'AINING WALL, CARPORT 0 ROOKERY RENEWAL -,-(rYP9:OF Z fn ITS CHECKED BY japs U.C`EIQN OCCUPANT)-3� R o c:,"A6 t, h gLe GROUP 0 NUMBER NUMBER OF CRITICAL -d- WELLING ARCAS SPECIAL INS CTCfR AREA OCCUPANT �F PE j L 0 _n UNITS NUMBER REQUIRED[:) YES LOAD DESCRIBE WORK TO BE DONE M 0 REMARKS PROGRESS INSPECTIONS PER UBC 108/1711NAL INSPECTION RECVD I�MAL� PN+ 14��61 61 _0_,v Ir 'itype. U. or L vent coffliftWrs reqtd z Ram IMC R15.1j., f Lx Lg_ f..� I*_-) wo 0) VALL UIGN S z Description FEE DescrlpUon FEE Plan Check M HEAT SOURCE GLAZING % LOT SLOPE % Building PLAN CHECK NO: VESTED DATE Plumbini Mechanical��, TMG PERMFr AUTHORMS ONY TNE WORK N0TED. THIS PEMrr COVERS WORK TO 1: BE DONE ON PRIVATE PROPIEM ONLY. AW CONSTRUCTION ON THE PUBLIC Grading Recording Fee 2 DOMAIN (CURBS, SIDEWALKS, DRIVIEWAVS, MARQUEES, ETC.) WILL REQUIRE SEPAR�ATEPMIMISSION. tz Engr.,Review City Surcharge 1Cxj PERMTFAIPPLICATION: 1190DAYS PERMIT LIMM I YEAR -PRWADED WORK IIII STffln1EQ WrTHIN 1160D�YS Engr. trispection State Surcharge SEE BACK OF PrNKPERMfr FOR MORIII INFORL*TION' BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Deposit ;AP:MO�N N RE . , AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON, ris OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Review Receipt # ALL CUUMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY FROM 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 CrTY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' I .N.U.Neee-0 Landscapainsp.1 Receipt # 1 HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION 105— APPLICATION APPROVAL GIVEN 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- TWs appilictallon Is not a pannh untli signed by the CALL 4P TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building OMeW or hlsftw Deputy: and Foes are paid. and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 4ecolpt Is acknawledged In epaoe provided. WORKMENS COMPENSATION INSURANCE AND RCW 18.27. OFFI6MQjGNAT)JRE DATE SIG RE�(OWN GE DAZ SIGNED 210 3 771-0220 IDA _r RELEASED BY ATTENTION EXT 1333 ------ IT IS UNLiWFUiL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 71,;-0221 A FINAL INSPECTION HAS,BEEN MADE AND APPROVAL OR A CERTIFI- ORKII"�-'FILE 4e�W'iNiPECTO CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FM PINK - OWNER - GOLD - ASSESSOR 10101