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20030934.pdfI DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWN R NAMEINAME OF SINESS (A) Efivil P r I Z'-b'A_ Bum ca 2a MAILING ADDRESS I -., --n ""I C') 0 ZIP TELEPHONE A --_� r-, - <k< -a, - NAME ADDRESS CITY ZIP ITELEPHONE NAME I CBL� ReAk- vlec'�a'n ca L ADDRESS ZIP I TELEPHONE IICENSE NUMBER ITY TAX ACCOUNT PARCEL NO. [:] NEW 0 RESIDENTIAL 0 ADDITION COMMERCIAL REMODEL MULTIFAMILY REPAIR GRADING CYDS DEMOLISH TANK oGARAGE CARPORT RETAININGWALL ROCKERY (TYPE OF USE, BUSINESS OR ACTMIVLAI�: NUMBER OF NUMBER OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE Ill - ' . I I I PERMIT EXPIRES 119' USE PERMIT ZONE NUMBER &RIM3_0q3i� JOB SUITE/APT# ADDRESS PLAT NAMEISUBDIVISION NO. T NO. LID NO. L D FEE S I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESOP Approved RW Porm Requited Parmit Raqd EXISTING — PROPOSED InapecOon Required 13 1 0A REQUIRED DEDICATION— FT Sidewalk Required 13 UnderWourld Wiringroquked METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE I r N ATE nON DATE RIA C VARIANCE OR CU A N SHORELINE OR ADB# INSPECTION BOND REO'D I I POSTED 13YEs 13NO $ E SEPA REVIEW S P SIGN AREA HEIGHT L E COMPLETE EXEMPT C 0 M P T ALLOWED PROPOSED ALLOWED PROPOSED EXP X P Ed"'PLU 131 E 7H M NO LUMBING/MECH /M C LOT C LOT COVERAGE kE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) Lo ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR 1 COMPLIANCE OR 0 _U CHANGE OF USE M z PARKING LOT AREA PLANNING REVIEWED BY DATE SIGN REO'D PROVIDED Ei FENCE X _FT) X REMARKS OTHER F RE SPRINKLER 0 FIRE ALARM CHECKED BY jTX0EwfW CON RU I C LIPANT,6 ORO CRITICAL AREAS SPECIAL INSPECTION JAREA OCCUPANT NUMBER REQUIRED [] YES LOAD ]REMARKS PROGRESS INSPECTIONS PER UBC IDS/FINAL INSPECTION REG'D tun - I % [A. 01= MA� Pdlora \)_hcw� :LrLs C4_-�1411 VALUATIOM Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE % LOT SLOPE % Building Permit City Surcharge VESTED DATE PLAN CHECK NO�,� Plumbing 7— Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO B It E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC Grading 3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 1180DAYS IL PERMIT LIMM I YEAR - PROVIDED WORK 113 STARTED WITHIN 100 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 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt # IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 2 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due IS x, NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFOR MATION 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 Th s application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OFAHE LABORXODE, OF THE STATE OF WASHINGTON RELATING TO OR INSPECTION receipt Is acknowledged In space provided. "SNCE AND RCW 18.27. WORKMENS CO1jfP NS�PP ,%� 1OFFICIALS SIGNATURE DATE SIGNATIJREUQA��N"T) DATE SIGT (AWA21"5) (y) , 771-0220 RELEASED BY D E ATTENT16-N— W 13 .0 b—VN— �i 6 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U TIL Uddl A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERT ORIGINAL -FILE - YELLOW. INLIP'EdTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 OPIES GREEN - ACCOUNTING 4 . RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing...................... . wall.......................... �y Pier/Porch ................. Retaining Wall ........... Slab Insulation ......... M: PLUMBING: 4 1 _'Underground ............. Rough -In ................... . Commercial Final M, ....... ID Z; HEATING:�': TGas: est ............ .......... Gas Piping ................. :Equipment ........ ... .11711 . C66imercial Final ....... E XT ERIOR SHEATHING, NAILING.......................... FRAMING ...................... FIRST FLOOR'FRAMING.. lit INSULATION ..... ............. YDATE RECWEQ CITY OF EDMONDS f%_nuQTn"r%ymKi 000RA111" A I If"A'll"Ir'likil bi"N PERMIT EXPIRES /9,3 USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS 127 F 2 ?Pa DZR NAMEfNAME OF BUSINESS &+ j,jj _ ( 0(a ca 2a r PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. MAILING ADDRESS I LID FEE $ Pu BLIC RIGHT OF WAY PER OFFICIAL STREET MAP TIESCP Approved RW Permit Required CITY zip TELEPHONE EXISTING - PROPOSED Street Use Perrywit Rec(d Inspection Required Sidews* Required REQUIRED DEDICATION- FT U.MWound Wiring required 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES C1 NO 13 z ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY zip TELEPHONE NAME CBL N lc_a L ENGINEERING REVIEWED BY DATE ADDRESS FIRE REVIEWED BY DATE CITY ZIP TELEPHONE 1 11C M 195 x9s,3-1) ;;Q1 STATE LICENSE NUMBER EXPIRATION DATE I CHE VARIANCE OR CU SHORELINE OR ADB11 INSPECTION BOND REO'D POSTED I is I ILk 13YES 13NO SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO, TE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED t�=*A -)()a I La(N-) I , , - EXP NEW RESIDENTIAL NG/MECH iTPLUMBI LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) FRONT SIDE REAR FRONT L/RSIDE REAR COMPL ANCE OR ADDITION COMMERCIAL P 13 CHANGIE OF USE [3 REMODEL MULTIFAMILY SIGN PARKING LOT REO'D I PROVIDED I AREA PLANNING REVIEWED BY DATE IL REPAIR [3 GRADING FENCE Aft . - a iv in I miiiiiiiiii CYDS x FT) REMARKS DEMOLISH TANK OTHER GARAGE -1 RETAJNING WALL FIRE SPRINKLER [3 CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR LAI CHECKED BY TX8fi-eF CON T114��_ OCCUPANT LIC GROUP NUMBER NUMBER OF CRITICA OF DWELLING AREAS UNITS NUMBER SPECIAL INSPECTION JAREA OCCUPANT LOAD _LTORIES REQUIRED [] YES DESCRIBE WORK TO BE DONE Rev�%v, e,)m)>, REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECVD -4n -)d -tt, -to - not acc-DML - OL (A n&A�)I VALUAnON $ P/ (Ag Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I= BE DONE ON PRIVATE PROPERTY ONtX ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION. 180DAYS PERMIT UMM I YEAR - PROVIDED WORK 19 STAITfED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit , ;APPLICANT, N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, US 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 Landscapalnsp. Total Amt. Due -A NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPRO L GIVEN IS CORRE" 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 Official or his/her Deputy: and Foes are paid, and IN VIOLATION F HE LABO OF THE STATE OF WASHINGTON RELATING TO OR INSPECTION, receipt Is acknowledged In space provided. _9X,0DE WORKMEN'S CO SA""SILItMCE AND RCW 18.27. FFIC44S SIGNATURE DATE SIG RE I'm DATE SlGku:D NY) 771-0220 -LEASED BY AMNTION Off 13 JE a J IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U TIL 1 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERT ORIGINAL -FILE YELLON- INSPECrOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING j z 0 ::I