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20030913.pdfDATE RECEIVED I III Mo" CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS MAILING ADDRfte aoNsq 483r4 Ave U). CITY ZIP TELEPHONE NAME ADDRESS CITY ZIP ITELEPHONE 14AME CBL ADDRESS 961% W44cidet Ave AJ, CITY .- ZIP TELEPHONE STAIE LICENSE NUMBER EXPIRATION DATE A — I PROPERFFY TAX AACCO NT PARC L !� :1 gEL NO. 6" e± E415+ 5aA%,VtS *Yes rw. [j NEW RESIDENTIAL PLUMBING / mECH ADDITION Ei COMPLIANCE OR COMMERCIAL CHANGE OF USE REMODEL 0 MULTIFAMILY SIGN REPAIR GRADING ci FENCE CYDS X FT) DEMOLISH 0 TANK OTHER oGARAGE RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, 8 5 Oil AC7IVrM EXPLAIN: NUMBER 1RI71C—AL OF STORIES UMBER DESCRIBE WORK TO BE DONE R er., I�J_ 111111111111111111112 1 1 Mir ea_* IN- I, n+ I %JI HEAT SOURbE GLAZING % LOT SLOPE % PLAN CHEr VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBIS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT UMM I PER141TAPPUCATION: 180 DAYS 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 PERMM ISSUANCE OF THIS PERMIT SHALL NOT HE DEEMED TO MODIFY WA114E OR REDUCE ANY REQUIREMENT OF ANY CITY ORD114ANCE 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 CORRE"- AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPUDYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WOCICMERS COMPENSATION INSURANCE AND RCW 18.27. SI E (0 NERO GENT) DATE SIGNED PERMITEXPIRES USE PERMIT ZONE NUMBER ";—' I)ql a) SUITE/APTO ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S TESCIP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PenrAt Requited Street Use Pernift Req'd EXISTING — PROPOSED Inspectlo" Required Sidew&tk Required REQUIRED DEDICATION- FT Undommund ' I Wiring required METER SIZE LINE SIZE I NO. OF FIXTURES I PRV RFOUIRFI 0 I YESX NO 13 z REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE REVIEWED BY DATE FIRE REVIEWED BY DATE W Or Ir VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND REO'D 113YEs POSTED 13NO;� $ SEFA'REVIEW SIGNAREA HEIGHT — COMPLETE EXEMPT ALLOWED PROPOSED AL LOWED PROPOSED 3XIM , I , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (IT) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR PARKING I LOT AREA PLANNING REVIEWED BY DATE I REO`D I PROVIDED CHECKED BY ITYPE OF.CgNSTRUCTION CODE OCCUPANT GROUP SPECIAL INSPEcTiONAREA OCCUPANT REQUIRED o 11ILMA11,11KO PROGRESS INSPECTIONS PER USC 11081FINAL INSPECTION EG-D 9 I I 11 Description FEE Description FEE PlanCheck State Surcharge Building Permit 4(6P— City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review PlanChk.Deposft Fire Inspection Receipt # Landscapeinsp. Total Amt. Due Recording Be Receipt # 3 CALL FOR INSPECTION 1Aq I APPLICATION APPROVAL This application is not a permit until signed by the Building OMcial or his/her Deputy: and Fees are paid, and receipt is acknowledged In space provided. OFFICIALS SIGNATURE DATE /l/a/. S 1 % — !�� ) ,ili V �!, .. 0 771-0220 LEASE 4kfd�� mo�� I I ATTENTION Off 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 71 CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 O��A -FjILE :YE LOVV-INSPECTOR 04/02 WNER - GOLD -ASSESSOR PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING V :1 z 0 0 M C M 0 0 C M 10 0M 0 Fn C 0) C V) M 0 z 0 1 0 M I RECORD OF INSPECTIONS I '�TE'IECEQED t-1111y, OF EDMONDS CONSTRUCTION PERMIT APPLICATION ER NAMEINAME OF BUSINESS MAILING ADDR9W a-% -% LL 0goovT 493" Avke U). CITY ZIP I TELEPHONE FA*vn A qqox NAME ADDRESS CITY ZIP ITELEPHONE NAME PERMIT EXPIRES U' PERMIT ZONE NUMBER JOB ADDRESS A Ave SUITE/APT# W.— PLAT NAME/SUBMSION NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Usul? App"mod RW Permit Required Street U" Permit Raqd EXISTING — PROPOSED Wpoeflon Required 81dewsk Required REQUIRED DEDICATION— FT underground Wiring required METER SIZE I LINE SIZE— OF FIXTURES PRVjlEQUIRE REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ENGINEERING REVIEWED BY DATE ADDRESS, 16 Aq c, le Ave AJb FIRE REVIEWED BY DATE CITY ZIP TELEPHONE IE 9:L 1412q VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND WCENSE NUMBER EXPIRATION DATE C C REO'D POSTED All IDYEs ONO $ 01SUSO&AV 1__1.7�1.j ____ ____ . SEPA REVIEW SIGN AREA HEI'3HT7PO Lf—I — - — COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PR SED PROPERTY TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY 0 REPAIR GRADING CYDS D EMOUSH TANK oGARAGE FIETAININGWALL CARPORT ROCKERY (TYPE'OF USE. BUS114 SS OR ACTIVITY]i EXPLAIN: 7-)) NUMBER NUMBER OF OF STORIES OWELILIN , G, UNITS t DESCRIBE WORK TO BE DONE Iont *—res lvw# EXP PLUMBING/MECH - LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED. FRONT SIDE REAR FRONT LIR SIDE REAR COMPLIANCE 08 CHANGE OF USE I I PARKING LOT AREA PLANNING REVIEWED BY DATE SIGN REOD PROVIDED FENCE I - FT) REMARKS OTHER — . zr 0 F RE SPRINKLER FIRE ALARM I. I CRITICAL AREAS NUMBER La �irj K'0011'n. J, An 44 H qs4e� Yr. Li a dre- nA ackAfni 'ah3 'C4 kkoz-e 4&vxw. 00- carc <L, A", I 'I Lo -1 tl- "I HEAT SOUIRtE GLAZING % LOT SLOPE % PLAN CHECK 140: VESTED DATE THIS PERMTT AUTHORMES ONIY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PIUBUC DOMAIN (CURSI�SIIDEWALKS, DRWEWAVS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT UMM 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 EDMOND% 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 umrT IN ANY WAY THE cnys AeiLrrY TO ENFORCE ANY ORDINANCE PROVISION. - I HrREINY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECr 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 VIQLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WO"EN'S COMPENSATION INSURANCE AND RCW 18.27. -wQf-- s 'tuilE (0 NER OR ENT) DATE SIGNED mp CHECKED BY ITYPE OF.CQNSTRU ON G S1 REQUIRED [3YES REMARKS PROGRESS INSPECTIONS PER UBC 1081 'M1 A%k IM OCCUPANT GROUP ' OCCUPANT LOAD EC . TION . REaDI is Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr, Inspection Fire Review., Plan Chk. Deposit Fire Inspection Receipt # Landscapainsp. Total Amt. Due Recording Fee Reicalpt # CALL FOR INSPECTION (425) 771-0220 EXT 1333 APPncA-nON APPROVAL This application Is not a permit until signed by the Building offlew or his/her Deputy: and Foes are paid, and receipt Is acknowledged in space provided. OFFICIALS SIGNATURE DATE C? R ELEASE DATE IT is UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I / I A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORI31 -FILE YELLOW-INSPECTO CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 O��NER GOLD-ASSESSO GREEN - ACCOUNTING 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES MENCER I =