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20030861.pdf0 - I I DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS MAILING ADDRESS CITY ZIP I TELEPHONE ADDRESS CITY � zip I TELEPHONE r ADDRESS .-,Zro_7V,f W dp� JAW4ff _IJE�2=mje; &?,r 14 1 a405_1 PROPERTY TAX ACCOUNT PARCEL NO. ff 2:92 7 _Q7 X NEW 0 RESIDENTIAL 0 PLUMBING / MECH 0 ADDITION 0 COMMERCIAL o COMPLIANCE OR CHANGE OF USE 0 REMODEL 5M APARTMENT 0 SIGN 0 REPAIR 0 GRADING CYDS FENCE 0 ( _X FT) 0 DEMOLISH 0 TANK HE o GARAGE CARPORT 0 RETAINING WALL tR ROCKr Y 0 RENffXL-40U46A4 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: __ - 1�'d`AfJ;b,411Jh`J4d NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS 1 1 r3 NUMBER IVA+ DESCRIBE WORK TO BE DONE HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO. IVESTED DATE PERMIT EXPIRES USE PER ZONE NIJIMBERC�m JOB SII ADDRESSJ,.k,g 'Z/ ZK L PLAT NAM E/SU BDIVI SION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0 RW Permit Required 0 Street Us* permit Req'd [3 EXISTING — PROPOSED Inspection Required 13 Sidewalk Required 0 REQUIRED DEDICATION � FT Underground Widnit required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES C3 NO 0 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE REVIEWED/DATE FIRE REVIEWED BY DATE U11 m VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REO'D POSTED 0 YES 0 NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSE D_, ALL OWED PROPOSED :XP I I LOT COVERAGE REQUIRED SETBACKS [FT) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR PARKING LOT AREA I PLANNING REVIEWED BY DATE I 1 REO'D I PROVIDED 06 CHE II TYPE OF CONSTRUCTION CODE OCCUP GROU�AN .11 Zo? SPEfCIAL INSPECTOR AREA IT Y REQUIRED [D YES LOAD REMARKS PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REI VALUATION PLAN CHECK, FEE, BUILDING 4t)W PLUMBING FEE MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE GRADING/FILL SEPARATE PERMISSION. STATE SURCHARGE PERMIT APPLICATION: 180 DAYS A 9 PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS `%I4FVtf&FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS OW69-PfC& 10 N F E E IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING Z EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE !E9 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT REC9 LOA 9 DUMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE o �61`1 LIMIT IN ANYWAY THE CITY'S ABILITY TC ENFORCE ANY ORDINANCE PROVISION." R C T� TOTAL AMOUNT DUE 7 —<HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION L7 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 CONSTRI 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 Foes 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. OFFICIAk5 SI NAT E DATE , SIGNATURE (0 rG DATE SIGNED 425) 771-0220 RE ED BY DATE ATTENTION EXT 1333 �ML, -d-5 Otl/ IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-022 1 4 11 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- II(SPEdTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 IZA& y PINK - OWNER - GOLD - ASSESSOR ;S1F FINAL PROJECT APPROVAL FORM 9 - I , DATE:, V2�k 12 z 9 0 M :q:—n V; --p, am c mo 0 0 c: M MZ () --I CA o -n n m M 0 0 0 M C co) c (D M 0 Z z co) z 0 q 3 m 3.. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Signature l:temp:bldg:forms:ocaprvl 3/25/04 . I; � . : - '* I' f 0 'ATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS (/_0-,sPprr< q, jr 71jazaA MAILING ADDRESS ize 4y Au-,-- �,,ny CITY ZIP TELEPHONE RILUM .0 ADDRESS 'TELEPHONE (42s) ADDRESS 14= LaUE MW U. --_Dv,n-" CITY ZIP TELEPHONE 5 � �7 , a,;, , /, J_A (4.7- 5 9 9M6J -, 0 STATE LICENSE NUMBER EXPIRATIONDATE I CHECKeQB]Y PROPERTY TAX ACCOUNT PARCEL NO. NEW 0 RESIDENTIAL 0 PLUM13ING / MECH 0 ADDITION 0 COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE 0 REMO DEL 50 APARTMENT 0 SIGN 0 REPAI R 0 GRADING CYDS o FENCE X FT) 0 DEMOLISH 0 TANK o GARAGE CARPO T REOTA NRING WALL 0 R C ' F Y K 0 RE9NQ'L0WA4 &74 (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: ".0.4pb 4!� AA 1,04 iij NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRI13E WORK TO BE DONE PERMIT EXPIRES USE PERMIT ZONE INUMBERC��,�A jOB UITE/APT# ADDRESS/ .A,y -J/ A &6-- 4!� PLAT NAME/SUBDI VISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW permit Required 0 Street Use Permit R*q d EXISTING — PROPOSED Inspection Required 0 Sidewalk Required E3 REQUIRED DEDICATION— FT Underground Wiring required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YEs 0 NO 0 cc REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE W� ENGINEERING REVIEWED/DATE FIRE REVIEWED BY DATE 6? VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REO'D POSTED C3 YES SEPA REVIEW SIGN AREA HEIGHT COMPLETE I EXEMPT ALLOWED R POSED ALLOWED , PROPOSED EXP 1 1 LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR z I PARKING LOT AREA I PLANNING REVIEWED BY DATE REO'D I PROVIDED 1 061 CHW OCC:UP PE OF CONSTRUCTION CODE GROUF�AeNj SPECIAL INSPECTOR I AREA OCCUPANT REQUIRED 0 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTII VALUATION FEE PLAN CHECK FEE HEAT SOURCE GLAZING % LOT SLOPE % BUILDING PLAN CHECK_NO- VESTED DATE goev, PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGtFILL DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. STATE SYRCHARGE PERMIT APPLICATION: ISO DAYS C6 PERMIT LIMIT- I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Vr—w8foFEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION 1 0 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS &4liffFP TION FEE IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE Cl I y OF LANDSCAPING 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM AN YAND INSPECTION FEE ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY REC17 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT A7z DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF, ANY CITY ORDINANCE NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' TOTAL AMOUNT DUE RECEIP�,, - /,24 d- A 6L 2 4� 1 I , /.�- Po I ev— 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 EMPI.OYED Building Official or hisiber 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. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIGNATURE (0 KG�; �) DATE SIGNED (425) O11FFICI NA�T_�, 71 7 -0220 REL ASED By ATTENTION EXT 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. 14S'PEC/TOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR 5/98