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20030935.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMENAME OF BUSINESS . MAILING ADDRESS ,-I 0-OR-0 CITY 6jMa NAME ADDRESS CITY NAME o� ADDRESS zffi &W-, Q. ZIP ITELEPHONE ZIP ITELEPHONE CITY I ZIP �fU'k1A)1bk_99)1 STATE LICENSE NUMBER PROPERTY TAX ACCOUNT PARCEL NO. TELEPHONE PERMITEXPIRES USE PERMI ZONE NUMB JOB SUITE R s L'ij PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Raquired street use Permit Rq'd rADDRESS EXISTING PROPOSED Inspection Required 13 Sidewalk Required 13 EQUIRED DEDICATION- FT R Ul UndetWound Wiring required 13 SI METER S12E M T LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NO 13 R M S z EMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE OW ICOI I I R required ain fuel-b!,—ningapplianmin CBL # unbeated spaces. UMC 815.1.7 NEW RESIDENTIAL PLUMBING ADDITION COMMERCIAL COMPLIAN CHANGE( 0 REMODEL MULTIFAMILY SIGN §VREPAIR GRADING 0 CYDS o FENCE 1:3 DEMOLISH 1 1:1 TANK OTHER GARAGE RETAININGWALL 0 FIRE SPRI CARPORT ROCKERY FIRE ALAI (TYPE OF USE, BUSINESS OR ACTIVITYI EXPLAIN: NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE FIRE REVIEWED BY W Ira NOW EOR SHO&ELUEOELADSO I.INSPECTION 13OND j r. I 'we nd&tngS3EQ'D POSTED IMES 13NO HEIGHT COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED EXP LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT) / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR CE OR z F USE PARKING LOT AREA PLANNING REVIEWED BY DATE REQ`D I PROVIDED X FT) REMARKS NKLER M CHECKED BY JTYPMCO CTION OCCUPANTa e C2VO�2- GROUP 0 ?r]A 17 1--- SPECIAL INSPECTION 'jAR9A_ OCCUPANT REQUIRED [_-] YES LOAD REMARKS ION REO'D I PROGRESS INSPECTIONS PER UBC I GO/FINAL INSPECT 9 VALUATION $ L A� f U-1-at Wv3 Description FEE Plan Check fp%T SOURCE T—GLAZING % LOT SLOPE % Building Permit PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPUCATION: 160 DAYS PERMIT UUM 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 IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. 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.* Recording Fee I HERE13Y 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- CALL TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED BI IN VIOLATION OF THE LABOR CODE OF THE STATE OF SHINGTON RELATING TO OR INSPECTION WORKME?J'S COMPENSATPN.14,SURANCE A,4 RCW 18.27. 1 1 IFF SIGNATUR NER 0 AGE 'E SIGNEY, (425) 771-0290 1 Description FEE State Surcharge City Surcharge I-S Plan Chk. Deposit Receipt # Total Amt. Due Receipt # 1 APPLICATION APPROVAL This appilcation is not a permit until signed by the ding Official or his/her Deputy: and Fees are paid. and receipt Is acknowledged In space provided. �:I LS §JGN�LURE DATE -, 7'�_j ) 1'2­70--03 le'l r -_ kSED B I DATEt ATTENTION EXT 3 ( ()t-j j1h\k, f(jk�_?A o�-) IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE TIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CER I- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 . 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES ORIGINAL - FILE YELLOW - INSPECTO PINK - OWNER GOLD - ASSESSOR GREEN - ACCOUNTING m 4-o 3tP.-I A-cu�.) p^rtl-x t..-t 104 WOO 00003 056 woo DATE RECEIVED PERMIT EXPIRES 10" USE PERMIT ZONE - — CITY OF EDMONDS NUMBER�?M JOB SUMARTL CONSTRUCTION PERMIT APPLICATION ADDRESS C) �n --R�� -n VY-1 LAO OWNER OF BUSINEP 7E"E eza' t' Kex YA_ PLAT NAMEISUBDIVISION NO. ] LOT NO. LID NO. MAILING ADDRESS efil-le-1 0 LID FEE S TE3UP AP=. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW POMM 0_�9e;�5 C TELEPHONE Strao Use Pam* Wd EXISTING — PROPOSED Impaction Required Sidewalk RequInA EAMaIL RE4UIRED DEDICATION— FT UndarWmW wmg uIred 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED (3 1 1 YES13 NO 13 I z 13 ADDRESS REMARKS OWNET"TPACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP ONE -ILype, i", Or h rent. NAME Cal. N uribeated sloams. UMC 815.1.7 PRENG ENGINE REVIEWED By DATE dc ADDRESS -'Abb �7'0�'Iu)ow FIRE REVIEWEDBY DATE CITY Zip �j TELEPHONE j_LLK '-S 1 VAF STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY L "�' (20-1 PROPERTY TAX ACCOUNT PARCEL NO. CON T!��a 13NO 1LETf__g_xEmPT _LVLWED -60-ND POSTED IGHT PROPOSED nMsq) M Inir) -7 T I EXP NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) FRONT SIDE REAR ED SETBACKS (Fr.) LIR SIDE REAR ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE PARKING 0- L T AREA REVIEWED BY DATE 0. REMODEL MULTIFAMILY SIGN REQ`D PROVIDED fPLANNING WREPAIR GRADING CYDS 0 FENCE X FF) REMARKS DEMOLISH 0 TANK ca 0 _n 0 GARAGE o RETAININGWALL o FIRE SPRINKLER FIRE ALARM CARPORT ROCKERY (TYPE OF USE, BUMNESS OR ACTIVITY) EXPLAIN: CHECKED BY ITYPMCO CTION OC CUPANT Sir Q..' Irn M NUMBER NUMBER OF CRITICAL SPECIAL INSPECTION OCCUPANT OF DWELLING AREAS 0 0 JARP STORIES UNITS NUMBER REQUIRED [:] YES LOAD co DESCRISE.WORK TO BE DONE ITI 0 REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECtO A -\I ^I UYI QQ A2 VALUATION s'31501.1 I co Description FEE Description FEE z 0 Plan Check State Surcharge GLAIIN13 11 LOT SLOPE % OU CE Building Permit City Surcharge rn PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT=0R&M6 ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading DONLAIN (CURBS, SIDEWALKS, DRIVEWAYS, LILARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERUITAPPLICATION. ISODAYS PERMIT UMM I YEAR - PROVIDED WORK 18 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 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 N OT BE LandscapeInsp. Total Amt. Due DEEMED TO MODIFY. WARM OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Receipt # Recording Fee kp(o) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPUCATION APPROVAL GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNErI. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit untli signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL Orr. EMPLOYED Building Official or his/her Deputy: and Face we paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF SHINGTON RELATING TO OR INSPECTIO receipt 13 acknowledged In space provided. WORKMEN'S COMPENSA3pN-LWURANCE " RCW 1827. FFICIALS SIGNATURE DATE SIGNATUR WNER AGE TE SIGLNE (42 771-02 0 Y DAT ATTENTION Off 3 IT IS UNLAWFUL.TO USE OR OCCUPY A BUILDING OR STRUCTURE TIL A FINAL -INSPECTION HAS BEEN MADE AND APPROVAL OR A CER I- ORIGINAL - FILE YELLOW - I SPECTOR U CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING . .. ............... . .....