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20030871 (2).pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NIAME/N&ME OF BUSINESS MAILING ADDRESS CITY —ZIP ITELEPHONE NAME ADDRESS CITY ZIP I TELEPHONE NAME 9 - ICBLN ADDRESS 5TY 5"a I STATIE LICENSE 91� WIE3k' PROPERTY TAX ACCOUNT PARCEL TELEPHONE PERMITEXPIRES USE PERMIT ZONE NUMBER JOB S ADDRESS V &502kA&' PLAT NAME/SUBDIVI;ION NO. _T LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP AP RW P..' PZV R 11. Streel Use Permit Racfd EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT ndwgrowd king required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I L YES 13 NO 13 9 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE I VARIANCE OR CU SHORELINE OR ADB# I INSPECTION I BOND I 113YE!SIE08NO 1$ POSTED SEPA REVIEW 3IGN AREA HEIGHT COMPLETE - EXEMPT I ALLOWED PROPOSED I ALLOWED - PROPOSED NEW PLUMBING / MECH LOT COVERAGE 0=EIV9VA4MMj I "Alp j&EAR_ PROPOSED SETBACKS (Fr.) UR SIDE REAR IRESIDENTIAL ALLOWED PROP N —IT DL; PAtSENT aft". ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE A k 1 IV/ r_! t I _Mr!jL10% z REMODEL MULTIFAMILY SIGN PARKINd F"q REQ`13 I PROVIDED_j_ LC" -AK DATE E] REPAIR GRADING FENCE CYDS I X FT) REMARKS DEMOLISH TANK OTHER [3 GARAGE RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACrWM EXPLAIN' CHECKED BY OCC U ITYPE-2"ONSTRUCTION Wit GROU 9:5 NUMBER OF rUMIL3ER 6F DWE LING CRITICAL AREAS SPECIAL INSPECTION OCCUPANT STORIES UNIT NUMBER REQUIRED [:] YES JAREA LOAD DESCRIBE WORK TO BE DONE REMARKS dQ PnOGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D 1,2wa& &:Z:: 1 $ V Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE NG % LOT SLOPE % Building Permit City Surcharge T 5� PLAN CHECK NO- VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading TC DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, E -) 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. Depositl !I IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF 3 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 Landscapelnsp. Total Anit. 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.-! -- Recording Fee i 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 Building Officiall or hIsfher Deputy: and Foos are pald, and IN VIOLATION OF THE LA DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPEN NC5,phND RCW 18.27. OFF LIRE DAT !9= WjNAj( SIGNAT 0 SIGNE jyj 0% F 771-0220 1714 RELEASED Br DATE Aft-ENTInC.'"'A"41 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- INSPECTOR 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 1 0 M =Pfi M M z 0 1 0 m :;9 OM c MO 0 -10 0 C -4 r. X M M Z g) --I c Cl) m 0 0 M C ca K CO) M 0 Z M z il CD z 0 m . I ocaprvl.doc.l:temp:bldg:fonns6/98 10% VJ mm 13 DATE RECEIVED h z,11)'; PERMIT EXPIRES USE PERMIT '0y CITY OF EDMONDS ZONE NUMBER 46 JOB Sul CONSTRUCTION PERMIT APPLICATION ADDRESS OWNEF R NAMEINVE OF BUSINESS PLAT NAME/SUBDIVISION NO. LID NO. M ILI a 5AN A0n1 LID FEE III CITY 1--lo NAME ADDRESS CITY NAME � ADDRESS _4�e ZIP ZIP TESCP ApprovAd PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pennit Required '6& , Street Use Pennit Wd TELEPHONE EXISTING — PROPOSED Inspection Rectuirod PUBLIC Fit CE N CG X'ST' Sidmalk Required REQUIRED DEDICATION— FT UndefWMW Q Wiringroquired 13 8 —7. OF FIXTURES PRV REQUIRED METER SIZE LINE SIZE YES 13 NO 1:1 z REMARKS C OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ZIP TELEPHONE CBL N ENGINEERING REVIEWED BY DATE FIRE REVIf0DJU N DATE Im ivi r ir. 1 6mbf IE VARIANCE OR CU SHORELINEORADE11 I INSPECTION 1$ BOND REQ'D POSTED 13YEs ONO SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED NEW PLUMBING I MECH LOT COVERAGE REQUIRED SETBACK$ (FT.) PROPOSED SETBACKS (Fr.) rESIDENTIAL ALLOWED PROPOSED FRONT I SIDE REAR FRONT LIRSIDE BEAR I ADDITION COM MERCIAL COMPLIANCE OR OF USE MEILT 1AAr%#^%Li_1 9 CHANGE illoftim-MY- 1:3 REMODEL muLnFAmiLy 0 SIGN PARI (IN REOD PROVIDED OT AhOA gT 8 r R I DATE PRESENT FOR 1:1 REPAIR GRADING FENCE !:AIqK I FILI., CYDS X ( FT) REMARKS M'- P CIVIUVAL, DEIMOLISH TANK OTHER [3 GARAGE RETAJNINGWALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM OWE OF USE, BUSINESS OR ACTIV" EXPI CHECKED BY 4STRUeCN OCCUP 1TYn_ P19GROU NUMBER BER 6F CRITICAL OF DWELLING AREAS SPECIAL INSPECTION OCCUPANT ST RIES UNITS NUMBER REQUIRED [3 YES JAREA LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REG'D V Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % 1 LOT SLOPE % Building Permit 1-6 City Surcharge P.LAN CHECK NO- VESTED DATE 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 Grading DO&WN (CURBS, SIDEWALKS, DRIVEWAYS, UARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PFRMITAPPLICATION:' 180DAYS PERMIT LIMIT: 1 YEAR - PROVIDED WORK 15 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 MATURE, AFUSING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CrrirS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." .' Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECr AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE M COMPLY WITH CRY 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 Officiall or his/her Deputy: and Fees ate paid, and IN VIOLATION OF THE LAB OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION fecolpt Is acknowledged In space provided. ;qDE WORKMENS CGMPENSA NC5AND RCW 118.27. OFFPW RE DAT SIG DAT SIGNED 1142-5) ,!IN 771-0220 —RE—LEAsED DATE 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. INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 GREEN - ACCOUNTING PRESS HARD -YOU ARE MAKING 5 COPIES t z 0 A 0 M M M 10 0 C � z M S z C4 0 _1111 "�n I M M 8 V; c) Fn C C M C) z 0 q 0 M