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20030873.pdfL= DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMMAME OF BUSINESS 11—% j NAME ADDRESS NAME ADDASS V. L j CITY tpa& STATr LICENSE h 16C PROPERTY TAX A ZIP TELEPHONE 771fl, 6 _�5X44�r Z --- ITELEPHONE IP BLPL ZIP TELEPHONE FAQ6 j.,qfjt4_ ,6Wr1_k?,q I? 0 NEW RESIDENTIAL PLUMBINGIMECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY 0 SIGN REPAIR GRADING CYOS r] FENCE ( X DEMOLISH TANK OTHER oGARAGE CARPORT RETAININGWALL ROCKERY FIRE SPRINKLER FIRE ALARM OWE OF USE. BUSINESS OR ACTWM EXPLAIN: (it " L 7 ) P rl 'm M J" S s- ;,e, NUMBER NUMBER OF CRITICAL OF DWELLING I AREAS I NITS NUMBER DESCRIBE WORK TO BE DONE 05 1 1 PERMIT EXPIRES USE PERMIT ZONE NUMBER'WV3 JOB ADDRESS Aoo�lde SUITE/APT# _��T PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESC=pro`n! RW Per t Raq ad Street Use Pernift Rati'd EXISTING — PROPOSED Inspection Required 93 sidewalk Required 0 REQUIRED DEDICATION— FT I Underground w1ringrequir 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE DATE FIRE REVIEWED BY DATE I -. VARIANCE OR CLI SHORELINE OR ADB# I INSPECTION I BOND REO'D POSTED SEPA REVIEW I —r—SIGN AREA 13YEs I 13NO $ HEIGHT COMPLETE . EXEMPT I ALLOWED . PROPOSED ALLOWED . PROPOSED LOT COVERAGE ALLOWED PROPOSED REQUIRED'67M UON r [JEE 1,.A ,,, PARKING REO'D I PROVIDED ribl'WhEA I [!�[XNN FT) I REMARKS V, x rl, AxAW2 �55 HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPE91Y ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: ISODAYS PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND 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 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION 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 CONSTRLIC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF TIJE LABOF.F.UNE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S C IN RVCE �RCW 18.27. — IOMKNDW !!�E ItNER OR kt7j6V St NED DATEr., J S.M I BACKS (Fr.) ems RRWIDE REAR I Am I 'OR CAP z �i R6qEwED BY DATE IL CHECKED BY ITYPEMrN CU NT COfF;r OC UPA GRO P SPECIAL INSPECTION AREA OCCUPANT REQUIRED [] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG-D VALUATION Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection FEE Description State Surcharge City Surcharge FEE Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due Recording Fee Receipt # APPLICATION APPROVAL CALL FOR INSPECTION Th a application Is not a permit until signed by the Buildinlg CrIficial or his/her Deputy: and Fees are paid, and receipt Is acknowledged In space provided. OFFICIALS IG L , kN4URE_ A IA-35) 771-0220 RELEA Da IF DAT—f— 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 I ----RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL ocaprvl.doc.l:temp:bldg:forms6/98 OM c Ma 0 80 c -4 r. 2: M MZ 10-4 0 -n n m m 0 Vi 0 o Fn C (j) r. (j) M 0 Z ;o z z 0 1 ?5 m 0 a .4 DATE RECEIVED FCITY OF EDMONDS CON STRUCTION PERMIT APPLICATION IOWNER NAME/NAMS OF BUSINESS ZIP 7741� NAME ADDRESS CITY I f ZIP .] I NAMEtri/ La "5 PERMITEXPIRES F ust PERMIT ZONE NUMBERVV3-040_7_�) JOB ADDRESS /?/W SUIMAPT# cr PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APPr0V@d RW Permit Required Street use Parmit RW EXISTING — PROPOSED inspection Required sidewalk Required REQUIRED DEDICATION— FT underground Witing required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED (3 YES 13 NO 13 ig REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE R BITY ZIP 9 __A4 L TELEPHONE ddd SlY2712 STAILLICENSE NUMBER EXPIRATIOI�DATE I C F16 C PROPERTY TAX ACCO CEL NO. 4 �2L NEW RESIDENTIAL PLUMBING/MECH COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE REMODEL MULTIFAMILY SIGN GRADING o FENCE X EYREPAIR CYDS FT) 0 DEMOLISH TANK OTHER GARAGE RETAINING WALL ci F RE SPRINKLER CARPORT ROCKERY FIRE ALARM WRE OF USE. BUSINESS OR ACTJY_" EXPLAIN: NUMBER NUMBER OF CRITICAL OF STORIES DWELLING UNITS AREAS NUMBER DESCRIBE WORK TO BE DONE YS7 DATE FIRE REVIEWED BY DATE VARIANCE Oil CU —1 SHORELINE OR ADBI I INSPECTION I BOND REOD POSTED 13YEs ONO $ SEPA REVIEW SIGN AREA I - HEIGHT COMPLETE . EXEMPT I ALLOWED . PROPOSED ALLOWED . PROPOSED LOT COVERAGE REQUIRED ALLOWED PROPOSED PARKING R REMARKS CHECKED BY SPECIAL INSPECTION REQUIRED [:] YES INSPECTIONS PER UBC PROPOSED SETBACKS (IFT) FRONT LIR SIDE . REAR� z cr%o 12 taW_L�� .AJIIIATE�� 211 OCCUPANT GRO OCCUPANT LOAD INSPECTION REaD 47/V 0/ fAllok /Aw tqmd VALUATION V Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit if _I City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mec anical THIS PERMIT AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Eq9r. j!qyiew_.-,- j PERMIT IUMM 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. Deposit IN INTEREST, AGREES -TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF X 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 Landscapelnsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITTS 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 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 IN VIOLATION OF UiF_LABOP0MqE OF THE STATE OF WASHINGTON RELATING TO Building Official or his/her Deputy: and Fees are paid, and FOR INSPECTION receipt Is acknowledged In space provided. WORKMENS INSURAVCE A 6S�i IVN� AW�RCW 18.27. OFFICIALS/SIGN61 SIGNAhRE J�tER OR W�MlrAig�e DATE SJUNED IA95) /i -% 111fur 1 771-0220 RELEA!rED Elf DAT9 ATTENTION M 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 n�' INE MEN