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20030957.pdfI DATE RECEIVED PERMITEXPIRES CITY OF EDMONDS U Z CONSTRUCTION PERMIT APPLICATION i A OWNER NAMEINAME OF BUSINESS A/C A ka Z r- , , " j MAILING ADDRESS CITY ZIP 0 it a ej_ ITELEPHONE zvas- NAME x E AbDRESS U CITY ZIP TELEPHONE 2= 4562. cz'- 92 ev rre-� NAME CBLN .41-liali, 12ja af,,-,t.j3 - 'ley ADDRESS f- 0: AeeAe- 64,1ne1e,11,ad AZZ 13RIX CITY ZIP TELEPHONE �5&rsyilco 6J4 9V-& (2040) STATE LICENSE NUMBER EXPIRATION DATE ED BY 'ry Aov�, 9 9/) a 1E 42 -,0 �HEC PROPERTY T ACCO PARCEL NO. J-07 e0l,!!9 �? I-z7fA NEW RESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE 08 CHANGE OF USE REMODEL MULTIFAMILY SIGN FENCE REPAIR CYDS X FT) 1:1 DEMOLISH 0 TANK [:] OTHER o GARAGE I RETAININGWALL FIRE SPRINKLER 0 ALARM CARPORT R0CKERY_____ FIRE (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMIJER OF CRITICAL OF ST RIES I DWELLING UNITS AREAS NUMBER DESCRIBE WORK TO BE DONE r HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE 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 t: SEPARATE PERMISSION. PERMIT APPLICATION: ISODAYS AL PERMIT ILIMIT I YEAR - PROVIDED WORK 15 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 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE 0 NOR LIMIT IN ANY WAY THE CnYS 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 EMPLOYE IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING WORKMEN!s C RANCS^ RCW 16.27. SIGNATUR�.fWNER OR, DATE SIGNED /0 - 117-le? SE PERMIT —7 ONE NUMBER _0qS CIS SUITE/APT# DDRESS ? rsi�� PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCIP Ap RW Perrnij=ad Street Use Parrvill Roq'd EXISTING — PROPOSED inspection Required 13 Sidewalk Required 13 REQUIRED DEDICATION— FT Underwound 1 wiring required [3 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES C1 NO C3 z 09 REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE NGINEERING REVIEWED BY DATE IRE REVIEWED BY DATE W cc r& VARIANCE OR CU SHORELINEORADBI INSPECTION BOND 13 REP-D I YES;NN'O 1$ POSTED SEPA REVIEW SIGN AREA HEIGHT ALLOWED PROPOSED , ALLOWED PROP I_— LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) 1LOWED PROPOSED FRONT SIDE REAR ONT URSIDE REAR z PARKING 1EO`D I PROVIDED 1 LOT AREA REVIEWED BY 0- -1,-- DATEJEY I - r, _ r itl ;HECKED BY I TYK OF CONSTRUCTIO 01 OCCUPANT .. 44k, GROUP P72 'PECIALINSPE' ION ' REA OCCUPANT 3 CTJ ;EQUIRED 'S LOAD 1:1 YES EMARKS PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION RE 'D z VALUATiON Description FEE Description FEE Plan Check /-16 State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review PlanChk.Deposit Fire Inspection Receipt # 70- Landscape Insp. Total Amt. Due Co Receipt # 2 Wb-r�dlng Fee APPLICATION APPROVAL' CALL This application is not a permit unul signed by the uIlding Official or his/her Deputy: and Fees are paid, and F, TION receipt Is acknoyAodged In space provided. �FICIALS SIGNATURE DATE (425) /7,8� 771-0220 RELEASED BY Aa ORIGINAL -FILE - YELLOWAPECTOR PINK -OWNER - GOLD -ASSESSOR 0 kilt = f%f%01=42 GREEN - ACCOUNTING A17ENTION Off 1 3 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U IL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 Tl� 04/02 PRESS HARD -YOU IONIC z 0 m :; 9 vi -4 am c ma 0 80 c 1 r, MM MZ 10-4 0 m M a 0 0 M C cj) c ch M 0 Z 7-1 z z 0 m 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Sign ocaprvl.doc.l:tenip:bldg:fonnsIO/OI Y7 I 4 ,0DATE RECEIVED PERMIT EXPIRES F CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS )410111 MAILING A DRESS ,7 160 /09/ 0 J, S7r L- & f _rELEPHONE CITY ZIP -7e-/ Q NAME CITY 644 NAME ADDRESS 39,RX C CITY 5er, 2, 1 A—C wo STATE LICENSE NUMBER PROPERTY ZIP TELEPHONE P/)!),^ I el -I <0- ZIP I TELEPHONE USE PERMIT ZONE NUMBER 9CO3 JOB SUITE/APT# ADDRESS 21 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APpMed RW Permit Rewired street use Permit RWd EXISTING — PROPOSED Inspection Required Sldewatk Required REQUIRED DEDICATION— Fr Underground IringfewIred 13 METER SIZE LINE SIZE NO. OF FIXTU�J" PRV REQUIRED I I YESO NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CBL N ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY 0, VARIANCE OR CU .- I 1 HORELINE OR At%# 46.� I k-�' INSPECTION] REQZ, 113YES--MO $ DATE �fHECKEO BY "$EPA REVIEW COMPL rE EXEMPT I :` SIGNAREA I ALLOWED HEI 61-LaMfEn 2f , i1PR2POUD 1 1_.� V I 0 NEW 0 RESIDENTIAL 0 PLUMBING/MECH '0 ADDITION 0 COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE 0 REMODEL 0 MULTIFAMILY 0 SIGN 0 REPAIR It 3 CYDS MANK o FENCE ( X FT) DEMOLISH - I OTHER GARAGE CARPORT RETAININGWALL ROCKERY F RE SPRINKLER FIRE ALARM (TYPE OF USE. BUSINESS OR ACTIVrM 1.111p_ NUMBER NUMBER OF OF DWELLING STORIES I I UNITS DESCRIBE WORK TO BE DONE .. . LOT COVERAGE I REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SID lba LIRJIDE REAR .J�Aj_ z PARKING OT AREA F�REVIEWED BY DATE 916 REO'D I PROVIDED ISX re AF I 71, -5 2 W2 A M oil CHECKED BY jr9E OF CONSTRUCTION CRITICAL AfxA 11"'re V 'TION 'JAREA AREAS SPECIALINSPEC NUMBER REQUIRED REMARKS I PROGRESS INSPECTIONS PER UBC J&ag A� -IF odor V $ Description Plan Check HEAT SOURCE GLAZING % LOT SLOPE % Building Permit PLAN CHWK NO: VESTED DATE eq — THIS PERMIT AUTHORINS ONLY THE WORK 7aTE THIS PERMIT COVERS WORK TO BE DONE ON PRIIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURB% SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPLICATION: ISO DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review -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 MATURE, 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 C17Y ORDINANCE NOR LIMIT IN ANY WAY THE. CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Fire Inspection Landscapel-nsp. 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 C17Y AND STATE LAWS REGULATING CONSTRUC- CALL TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYE 4 (:0 T S� IN VIOL rW �ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING FOR INSPECTION Cc P 0 N 8 tft 0 C C WORKMEFS CSPPENSATI0)Ij*RANC!PE^RCW` 18.27. SIG 7 WNER 01 j9ffffn - DATE SIGNED (425) NATUR 771-02 0 ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U IL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD -YOU ARE EXT 133i�' OCCUPANT GROUP. OCCUPANT LOAD .1 , I INSPECTION REO'D FEE Description StateSurcharge ity Surcharge _�w Plan Chk. Deposit / 55 &f 6%4j Receipt # Total Amt. Due Receipt # APPLICATION APPROVAL" This application is not a permit until signed by the U ng Ot Ilding OMcial or his/her Deputy: and Fees are paid, and I r rac. eceipt 13 acknovAodged In space provided. Cl Ls DATE FICIALS SIGNATURE wzq , s RELEASED BY ( DATF NG 5 COPI1 � ch;��K_ 0-510 3 1 ORIGINAL -FILE Y7� 41PE EI1OW-I , PINK -OWNER GOLD -ASSESSOR GREEN - ACCOUNTING WINED