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20030891.pdfI /A&A�DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION P*WNERR NA41EINAME OF BUSINESS ��CLA S 15 MAILING ADDRESS 0 Ljj,) -76 4J a.r CITY ZIP I TELEPHONE N ADDRESS CITY ZIP _fTELEPHONE NAME CBL # ISDL� PERMIT EXPIRES USE PERMIT ZONE NUMBERi J013 < VIZ-1, F" 7 _14ce-cwtN SUITE/APT# ADDRESS fol- r 22,2c) A'W,.,AA PLAT NAME/SLIBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Permit Req'd EXISTING — PROPOSED— Inspection I lquired Sidewalk Required REQUIRED DEDICATION— FT Underwound Wiring required METER SIZE LINE SIZ�7, OF FIXTURES PRV REQUIRED YES C] NO 13 REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE ENGINEERING REVIEWED BY DATE -hdk. - — I le li IF " %_ t= ' JFIHIE IREtMED Lll_�14 DATE us CITY ZIP I TELEPHONE f_7 cc . Ital-136,11 IQ& STATE LICENSE NUMBER Piilj-aZ�F Po") JcF IROPERTY TAX ACCOUNT PARCEL NO. NEW [:] RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY REPAIR GRADING CYDS DEMOLISH TANK GARAGE [3 RETAININGWALL CARPORT ROCKERY OF USE, BUSINESS OR ACTIVITY) EXPLAIN: -7E 9%12y- _If�NUMBER -ov NUMBER h OF OF DWELLING STORIES LIN" UNITS DESCRIBE WORK TO BE DONE HEAT SOURCE GLAZING % PLAN CHECK NCX FON DATE Y ECKED Y &" "_U� 11 f 1-7tO-Y IANC OR CU,/ $H�ELINEORADB# INSPECTION BOND IEL WECKED I REO'D POSTED .L 13YEs ONO $ ON SEPA REVIEW SIGN AREA HEIGHT C COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED E EXP , I , PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) A LLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR 0 COMPLIANCE OR 'I z 13 CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE SIGN REOD PROVIDED I I I FENCE X Fn REMARKS OTHER CHECKEDBY ITYPE! STkT ONSTRUCTIO HK 1 CJE�_ I OCCUPANT GROUP B CRITICAL AREAS N1,4 SPECIAL INSPECTION 4��, AREA r OCCUPANT NUMBER d!REMA®RKS REQUIRED [:] YES LOAD 2 PROGRESS INFSPECTIONS PER UBC 108/1FINAL INSPECTION REO'D LOT SLOPE % VESTED DATE 1/ 2 — �2 Z.1 I 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 SEPARATE PERMISSION. PERMITAPPLICATION: ISODAYS PERMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION VALUATION $ 1/0 PA co Description FEE Description FEE Plan Check 4 State Surcharge Building Permit JLP City Surcharge Plumbing 1 i--A Lo Mechanical Grading Engr. Review Engr. Inspection 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review A5 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 # 45, hQq 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 If) . I NOR LIMIT IN ANY WAY THE CITYS ABILffY TO ENFORCE ANY ORDINANCE PROVISION. - Recording Fee 1 Receipt # I HERESY 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 1771-0220 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a pefirnit unUl signed by the TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Official or his/her Deputy: and Foes are paid, and receipt Is ackncrMedged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. IfA9 1425) OFFICIALS SIGNATURE DATE SIGNATURE (OWNER ORXGE DATE SIG�NE /9,a. V"I, d _3 __ ATTENYION EXT 1333 LEA TE A IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGOIFILE - YELLOW INSPE CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PIN NER - GOLD -ASSESSOR '--�04/02 GREEN - ACCOUNTING PRESS HARD -YOU ARE MAKING 5 COPIES I = FINAL PROJECT APPROVAL -FORM a 2. 3. pECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL RE -INS Si Date ocaprvl.doc.l:temp.-bldg:formsIO/OI z 9 0 m =i:fi m rn 0 0 80 3: rn M Z 0 -n n mm a 0 0 M M 0 Z M z CD z 0 m DATE RECEIVED PER IT PIRES CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OVM�rEINAME OF BUSINESS VXV.�'S. Melnvo,( MAILING ADDRESS ,;2 / & ()j) -76 4-,L CITY ZIP �.JTELEPHONE FA kkov, �4 NAME ADDRESS CITY ZIP USE' PERMIT ZONE NUMBER JOB 3z"� 8 [MAPT# AIDTJ 9 .5� S 0 r PLAT NAME/SUBDIVISION NO. LOT NO, LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE5GF APPr0Ved RW Permit Required street use Permit R00 EXISTING - PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION- FT Urmleriyound WirIngrequirad 13 METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED I I YES 13 NO 13 NAME I -A I CBL# ADDRESS 041, ZIP 179111;)q TELEPHONE M3-ldti, - STATE LICENSE NUMBER EXPIRATION DATE PM- aT7F Po I cl c F 10100# PROPE C EL 06 0 1�? ?0 1 NEW RESIDENTIAL PLUMBING MECH COMMERCIAL COMPLIANCE OR ADDITION CHANGE OF USE REMODEL [3 MULnFAMILY SIGN GRADING CYDS FENCE REPAIR X FT) DEMOLISH TANK OTHER GARAGE RETAININGWALL CARPORT ROCKERY -FIRE ALARM OF LIFE. BUSINEV OR ACTIVITY) EXVN: R NUMBER -OF � / , NUMBER OF DWELLING CRITICAL AREAS STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE I . I I HEAT SOURCE I GLAZING % I LOT SLOPE % PLAN CHECK 5 VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY OHLX ANY CONSTRUCTION ON THE PUBLIC I DOUAIN (CURSS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE :3 SEPARATE PERMISSION. I- PERMITAPPLICATION: 188DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS SEE BACK OF PINK PERMIT FOR MORE IHFOFWATIONj 4 'APPLICANT. ON BEHALFF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUC&SORS' IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF ED MONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR IND RE 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 CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORMENS COMPENSATTUIRURANCE AND RCW 18.27. SIGNATURE (OWNER 0 %AGEIV DATE SPNEP C�A— _ 1,-A,— . I //// VJ'3 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE DATE 0 z I z z P FIRE IR ED DATV Ld A ft to-7103 WIE RIANCE OR CU` SH RELINE OR ADB# INSPECTION BOND REO'D 113YEs POSTED 1$ 13NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I I I , LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR PARKING LOT AREA I PLANNING REVIEWED BY CL RE(YD I PROVIDED REMARKS CHECKED BY SPECIAL INSPECTION REQUIRED [:] YES It .0,01 00 ,, -k Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection !Fli�e Review i, Fire Inspection Landscapeinsp. Recording Fee CALL R INSPECTION 1A'05)%IWIQ 771-0220 EXT 1333 CTIOJP--,p OCCUPANJO� GROUP OCCUPANT LOAD PER UBC I GO/FINAL INSPECTION Rtab I a Description_ State Surcharge City Surcharge FEE 7Z Plan Chk. Deposit 45 41 Receipt # Total Amt. Due Receipt # 1.2-31 &,If APPLICATION APPROVAL TWs application Is not a permit untu signed by the Building Official or hisMer Deputy: and Fees are paid, and receipt Is acknowledged in space provided. NATURE DATE ot) // 1,;�41z 9i;, IT IS UNLAWFUL T6 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGr _�J-FILE - YELL04INSPICTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P NER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING I 2 z 0 ::I 0 M "4:% us � OM C M M M jo F, z 0 M M Vj rn X z 0 11 0 M