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20030830.pdfM &111W66Y_ 1,117-S;�VZW DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS !L i MAILING ADDRESSI` ;�� (-�! f'"N CITY ZIP S7- ct !i); NAME ADDRESS NAME TELEPHONE �/.zs - -7 -7 ) - TELEPHONE f/. 2, J d!:'3 " 7 1CBL# ADDRESS f —7 Z rp- ELEPHONE qg:�� 3 83- STATE LICENS;F qNECKE ,#& D BY i,V / EXPIFLVION Uzi MA C_ i5; a n PROPERTY TAX. ACCOUNT PARCEL NO. NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY REPAIR GRADING CYDS ,KDEMOLISH TANK oGARAGE RETAININGWALL CARPORT ROCKERY OWE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: NUMMER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE PLUMBING / MECH COMPLIANCE OR CHANGE OF USE SIGN oFENCE ( _x FT) OTHER 0 FIRE SPRINKLER FIRE ALARM Z0, �5 j I PERMIT EXPIRES USE PERMIT ZONE J-JaNUMBER "Lg JOB SUITE/APTf ADDRESS 13,4111-46-2i PLAT NAME/SLIBDIVISION No. LOT NO. LID NO. LID FEES TESCF Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Perrvill Required Street Use Permit Raq�d EXISTING — PROPOSED inspection Required SidewsARequired REQUIRED DEDICATION— FT Underwoum Wiring roquired 13 METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED I I YES13 NO 13 a5 REMARKS � I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z / — is REVIEWED BY DATE FIRE REVIEWED BY DATE 11' VARIANCE OR CU SHORELINEORADB# INSPECTION I BOND REO'D I POSTED E3YEs 13NO 1$ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , I LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR z PARKING BY 9ATE REO'D I PROVIDED I LOT AREA PLANNING REVIEWED I CHECKED BY JTYPE tCONSTRUCTION CQQE OCCUPANT OF-7 GROUP CRITICAL If 1 91 1 — AREAS SPECIAL INSPECTION AREA OCCUPANT NUMBER C>2-132 1 REQUIRED [] YES LOAD REMARKS 2 PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D $ , I Description FEE Description FEE Plan Check State Surcharge HEAT SOuR GLAZING % LOT SLOPE % Buildi ng P I ermit City Surcharge PLAN ICII VESTED DATE Plumbing Mechanical if THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, FTC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE 13ACK 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 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 Landscapeinsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - Recording Fee Receipt #_ c I HERE13Y ACKNOWLEDGE THAT I HAVE READ TH S APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT. AND THAT I AM THE OWNEZ OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This applicallon Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Officiall or his/her Deputy: and Face are paid. and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. �y __ - 09C G DATE SIGNATUR I ii o87 - SIGNED IA9 025) All &N, �DATE 771-0220 ---- REL ED BY IfATE Alff *TfON M 1333 IT IS UNLAWFUL TO USE OR 6CCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- INSPECTCIR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 m 3. RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL Date Si ocaprvl.doc.l:teM:bldg:fonrLsIO/OI z 0 1 0 m =i 9 m ma 0 80 c ic 3: M rn z Jo m ca 0 -n n m M a V; 0 o rr; CA M 0 Z .q M z z 9 0 m RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing..................... Wall........ ......... ....... Pier/Porch Retaining Wall ........... -W m Slab Insulation ........... PLUMBING: I I;DA;TE RECEIVED PERMIT EXPIRES r UIbE PERMIT CIT�YWFEDMONDS I ZONE P—INUMBER q�06-,05?�1?4 CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS C' , 't , MAILING ADDRESS( z C> 0 CITY ZIP TELEPHONE r___4 A-f C( c? NAME 17 'E� 1;2, ADDRESS 100F 2--C—C, -7 g( CITY ZIP TELEPHONE zem /3=� K? 7 NAME CBL ADDRESS CITY Zrp TELEPHONE -3 ZOE— I SUIMAPT# ADDRESS 7L PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appmed RW PofnVI Required Peffnil RWd EXISTING — PROPOSED _ hupectlo" floquked Sidewalk Required REQUIRED DEDICATION— FT Underground WWgrequirod 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 1 I 1 YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAIN GE 6 -1 th 4,.e A-.,, (z- ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE STATE LIC E gU;qF& EXPI?1GN DATE C ECKED BY VARIANCE OR CU SHORELINE OR ADBN I INSPECTION REQ'D 13ycs 13NO $ BOND POSTED K0 SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , mEW RESIDENTIAL 0 PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr) ALLOWED PROPOSED FRONT SIDE REAR FRONT LfRSIDE REAR ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN PARKING RECID PROVIDED AREA PLANNING REVIEWED BY DATE I REPAIR GRADING CYDS FENCE ( X FT) A I Fm FA REMARKS III _ff IKDEMOUSH TANK 0 OTHER a a oGARAGE [3 RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM OWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKEDBY I TYPE Or- CONSTRUCTION OCCUPANT A *enj� GROUP '-2ftA I CR NUMBER NUMBER OF ITICAL OF DWELLING EAS SPECIAL INSPECTION AREA OCCUPANT STORIES UNITS YES LOAD U NRUMBER REQUIRED [3 DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/171NAL INSPECTION RECrD J VALUATION Description Plan Check HEAT SOURPE GLAZING % LOT SLOPE % )(11.a Building Permit PLANIC VESTED D*TE 'nf Plumbing Z2 Mechanical THIS PERMIT AUTHORUMS ONLY THE WORK NOTED. THIS PERMIrT COVERS WORK TO t: BE DOME ON PRIVATE PROPERIV ONLY. ANN CONSTRUCTION ON THE PUBLIC Grading 31 3 DOMAUN (CURBS, SIDEWALKS, ORNEWAM ItlIAMUEES, ETC.) WILL REQUIRE L SEPARATE PERMISSION. Engr. Review PER ITAPPLICATIOW ISO DAYS PERMIT LIMIR I YEM - =DED WORK IS IsTARm'wrmim iso DAYS Engr. Inspection SEE BACK OF PINK PERMrr FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCE80RS Firo Review IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C17Y OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS rROM ANY AND Fire Inspection ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMff. ISSUANCE! OF THIS PERMIT SHALL NOT BE Landscapelnsp. DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT tN ANYWAY THE CITYS ABILIITYTO ENFORCE ANY ORDINANCE PROVISION.* Recording Fee I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPILICATION; THAT THE INFOAMATION GI1VM 13 CCIRRECr AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER I AGREE TO, Y WITH APY AT LAWS 4GULATING CONSTRUC. 6 'r ON APS TION. AND & DOINP E _EC WILL—ar YTO H��O�P 2 1/ x C A4 . . a ( TV IN VIOLATION OF H ' IRE TH[t Tg� F 8 GTOFF IRE G I TH T F 0j I WORKMENS COMPqSATIONI INSURANCE AN 'jRCW 18.27. FEE Description FEE State Surcharge City Surcharge Plan Chk. Deposit Receipt # Total Amt. Due Receipt # Z tAPOW PPROVAL This applicatiT.2m a permit until signed by the BuOdIng OMCW ci Ns/Mr Deptily: and Fees are paid. and . receipt Is acknoyAodgad In space pf ovided. 0 cl ION DATE BIGNATU (0 RO DATE SIGNED (42 PIP," - CK. e, 771'-0220 AtTOWON EXT 1333 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 - I CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 f 0 m m C m N 0