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20030922.pdfq DATE RECEIVE cisisy&EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS 9- 3 � — / �_> IrA(A i,�� A/ CITY Z TELEPHONE Lplf� t21101 <-- Z/.-)�/z NAME ;V&L�� CITY ZIP ITELEPHONE NAME cz-2:L_ P" SA1e_,w61f1f()_ ADDRESS 2±fZ ZIP I TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY �-L /— f- __ I IR06-6 TiA�XizCOUNT PARCEL NO. 1— 0 zo— 90 ro NEW RESIDENTIAL PLUMBING/ MECH 0 ADDITION [3 COMMERCIAL [3 COMPLIANCE OR CHANGE OF USE REMODEL 0 APARTMENT 0 SIGN [3 REPAIR GRADING CYOS o FENCE X ( __ _ FT) DEMOLISH [3 TANK OTHER o GARAGE CARPORT [3 RRETAINING WALL OCKERY 0 RENEWAL (TYPE OF USE. BUSINESS OR ACTIVnYj4RfPkAIW._ :,—> I— P, NUMBER NUMBER OF RITICAL CAREAS OF DWELLING STORIES UNITS NUMBER tV DESCRIBE WORK TO BE DONE _1�j A Jr HEAT -SOURCE GLAZING LOT SLOPE % F PLAN CHECK NO: /) �Z. VESTED DATE Gl� THIS PERMIT AUT14ORIM ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPEFTry ONLZ ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 11110DAYS PERMIT ILIUM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS BEE 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 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMENS COMPENSATION INSURANCE AND RCW 1!2!. TUREf(OWNER J)R AGE DAT SIGNEP /* Al'TENTION I IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN' A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 10/01 tt.7-1 j[PERMITEXPIRES Usr— PERmrt ZONE � 2�7 NUMBER JOB SUMAPTO ADDRESS PLAT NAME/6�1.113DIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFF161AL STREET NW TESCP APP"rved RW Porn* ReWired Street Use PsmA Reld EXISTING _,pnopoaED Inspectlo" flaquked 1. 1 .; S1d*W&*R*qu1r*d REOUIRED DEDICATION FT . 77 UnderWmM Wiringroquired 13 METER SIZE '-[-�_U OF FIXTURES PRV REQUIRED V-,.'Iii7N0, YES13 NO 13 z REMARKS �CO —0. OWN MR EROS ON NaOUDRAIN4GE , 70bt3a!n E_1e_c7Tr1cai Fre-irmit ]iF%RU t. S WzVe Eabor ENGINEERING bLpATE FIRE REVIEWED BAFFIDAWS SHALLFW I DATE HE ACCEPIED W 01 VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND REO'D POSTED [3 YES [3 NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOPED :XP < , _60" 1 LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR PARKING LOT AREA REVIEWED BY DATE(:�.. REO'D I PROVIDED IMIG 11: N I L.,e-- V-%ntk-% no � '__ V.-I . I CHECKED EOFCONSTRLFCTION 1comr- OCCUPANT ,�D F GROUP 102 By SPECIAL WPECTOR AREA OCCUPANT REQUIRE YES LOAD rRhOG 0 INSPJLM artVIMMIMSPECIT910N EO'D 9 AYPU A, ILI required 111 fuel-billmingappliancW i2 T, lated spacm U[qC 815.1.7 VAWATION $ FEE I Description I FEE Plan Check Plumbing Mechanical Grading Recording Fee Engr. Review City Surcharge Engr. Inspection State Surcharge Traffic Mitigation Plan Chk Deposit Fire Review Receipt # Fire Inspection Total Amount Due Landscapelnsp. Receipt # APPLICATION APPROVAL CALL This application Is not a permit until signed by the F I N ION Building Official or his/her Deputy: and Fees are paid, and receipt is o6nowledged In space provided. 7SP (425) OFFICIALS SIGNATURg DATE 01, �.,rbut�L 771-0220 L D E EXT 1333 71-0 7 10 _7 M ORIGINAL - FILE - YELLOW - INSPECTOR 0 PINK - OWNER - GOLD - ASSESSOR (12rH AVEtjj 4NA" EXISTING ICAR GARAGLE SWIUWNG L A" POOL EXISTM SINGLE FAUILV RESIDENCE NO CHAA" 1#0 CHANGE aWC PAT10J% F7 �. Q�vl, v moyispowar qion r OVER ERSI"I'll'of jorr ,7ATE ro t .7 ISE a" A L E%A I A VE P*#Nl NO 9AMSE 0 SAM fu rNr IV, - Niv T00m. 0 $run I inVerbusaaf oaAtm V. 0 JfCAV4 L r L,,... a - 0`7 w fd four OF ME NO CITY Ce gem orso LOT is iswroft "U"Iso 6%Ar ON.voL &opes. SNONOW85H COLWrY. *A-, rA)f to NO.: som-000,018. PARCIt. NO% "ir mr A PA�OVED �By P�IAIVNJNG Nort To A'MANFEINEW CA&CV&ArfgNl sEnwr "mmilrAL =air W W V-it r p r q 14 C '41TY COPY p 9 I %V; A: 'J.1 4k RECORD OF INSPECTIONS D ATE APPROVED INSPECTOR SETBACKS' .4 ................. FOUNDATION: X MW i "f,'F6bting ........ Jr. ..s., fe .,--) ." -, so 01 1. . ......... Retaining Slab Insulation .......... PLUMBING: und .......... Undergro Roughain ................... Commerc al Final ..... jo HEATING;., s GasTeSt, . . . ............. -Gas.0lplhg . ............. .,.,E ulpmenV, �Cornrnerclill Final ....... ........ c: EXTERIOR SHEATHING ic it NAILING .......................... . 3 I ......... CITY OF EDMONDS CONsTRucTidN PERMIT APPLICATION E 79F DU_ MAILING ADDRESS 93 / - 01 CITY ZIP TELEPHONE J5� NAME ADDRESS CITY ZIP TELEPHONE NAME of'Sp+A A, -� ) ADDRESS S.04 EF. CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE PARCEL NO. — ^/ fe— [3 NEW arRESIDENTIAL ADDITION [3 COMMERCIAL REMODEL APARTMENT REPAIR_ [j GRADING CYDS [3 DEMOLISH TANK 13GARAGRET [3 RETAINING WALL CARPO ROCKERY (TYPE OF USE� BUSINESS OR ACTlV1T*0MvW_ NUMBER NUMBEROF OF STORIES DWELLING UNITS DESCRIBE WORK TO BE DONE _Jvs e I W1.1 LA PLUMBING I MECH COMPLIANCE OR CHANGE OF USE SIGN [3 FENCE ( _ X FT) OTHER [:] RENEWAL 0L) PERMIT PIOIES PERMIT ZONE / NUMBER od\ SU ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC ;IGHT OF WAY PER OFFICIAL STREET MAP TESCP Appro"d RW PerrrJt ROWIr sulm use Ps EXISTING — PROPOSED kopeedw Ploquked SW*wa* Requm REQUIRED DEDICATION— FT I UndwWo-d WMgroq*sd METER 8 1 RES PRV REQUIRED =V-±E NO 13 RE Al%twa "AMJAGE 0 E aw"JawRea SttAe Labor & Industries I _j ENGINEERINGOBSERVED BY -CITY 1111MA -rt% - 6=151111 FIRE REVIEWED BY as a - mrv= 11111W I DATE BE ACCEPTED VARIANCE OR CU SHORELINE OR ADB# INSPE ON BOND R � QDD POSTED P.-Mmooft 00-106 E3 Y ES [3 NO SEPA REVIEW SIGN AREA . HEIGHT COMPLETE EXEMPT ALLOWED "OPOSED ALLOWED PROPO ED , < �:+XP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR PARKING LOT AREA I PLANNING REVIEWED BY .;DATE01 REQ` IDED 4----ja '_ CH9CKED BY E OF CONSTRLICTION C OCCUPANT j 12=12 /L GROUP CRITICAL t=c�� C H AED L 'w AREAS SPECIAL EOT07RAREA OCCUPANT S NUMBER LREQUIREIC :S LOAD /4,40 M 8 MARKS r_7__ UHE%&aMCMCW 110MMM0110INIANECTION R GeD —,Tl 44C -- ,,uj,,ed jin fuel-buridng appliancelili a VALLIATION Melcription Plan Check f HEAT BOUT= GLAZING % LOT SLOP . E % Building PLAN CHECK NO: VESTED DATE Plumbing Mechanical TM6POO"MrHO11IM80MYTHM*IWKOOTKD. THIS PERMIT COVERS WORK TO ISE DONE ON PRIVATE PRMJM OMM AW CONMUCTION OH THE PUBLIC Grading DOLMN.(CUM SIDEWALK& DMVEWAM MARQUEES, ETC.) WILL REQUIRE BEPARATII PFMISBIOOL Engr. Review PEnmrropucAii� too DAYS PERMIT LIMM I YEAR - PROVIDW WORK 13 STARTW WITHIM 100 DAYS Engr. Inspection SU BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS 00 HER SPOUSE, HEIPS, ASSIGNS AND SUCCESORS. Traffic Mitigation REST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE Cri V OF EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM.. ANY AND Fire Review ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT IS$UANCE OF THIS PERMIT SHALL NOT BE Fire Inspection D11EMEDJOVOIDUN WAIVE OR REDUCE ANY &dUIREMENT OFANY Crfy, ORDINANCE NOR LWIT IN ANY WAYTHE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Landscapeinsp. I HEREBY ACKWWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION GIVEN IS COPRECr. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNEFL I AGREE To C0fjPLy WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL 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 9 INSPE WORKMENS COMPENSATION INSURANCE AND RCW 18, FEE a RE (OWNER AG DATE SIGNE (44.25) 7e. 771-02201 ATTENTION Off 1333, /1 IT IS UNLAWFUL TO USE OR OCCUPYA BUILDING OR STRUCTURE UN L R 4 1 V A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A dE TrIF 77,1-0 CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 10101 FEE Recording Fee '0:z, City Surcharge State Surcharge Plan Chk Deposit Receipt # Total Amount Due Receipt # APPLICATION APPROVAL This application Is not a permit until signed by the Building Oflicial or his/her Deputy: and Fees we paid, and receipt Is acknowledged In space provided. OFFICIALS LIGNATURI� DATE ft) . � Y100 WELEA,SIED By ORIGINAL - FILE - YELLOW - INSPECTOR PINK - OWNER - GOLD - ASSESSOR k z 9 0 M =i T, 7W � Q M C M ; -48 3 q 5! 1C IT1 M 0 _n �n I ITIM 0 V3 0 0 C C 0) M 0 z X 0 z z 0 q 5 M