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20030971.pdfa IVED 6_o A,� I I PERMIT EXPIRES 10— /0 CITY OP�DIVIONDS USE PERMIT ZONE NUMBER 0003- 071 CONSTRUCTION PERMIT APPLICATION JOB d APT ADDRESS 0 ER NAMEINAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. fill in Allin i., P-n± LID FEE $ _%xju-- MAILING ADDRE&S ICIV -6 5A PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING — PROPOSED REQUIRED DEDICATION— FT TESCP Approved RW Permit Required Street Use Parmh Roq'd Inspection Required 13 Sidewalk Required 11 Underground Wiring required 13 CITY ZIP 4�43c;�- TELEPHONE NAMP METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 z ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z CITY ZIP TELEPHONE NAME JCBLN PDOF 00 z 0 1 Aj E_ ENGINEERING REVIEWED BY DATE ADDRESS Ll 9C FIRE REVIEWED BY DATE tu W ri CITY ZIP T LEPH E TVffLUILA q9'16 le M �j q 39 - qc?q I VARIANCE OR Cull I SHORELINE ORAD1111 "IN ql_lf;,7_ INSPECTION REO'D [3 YEs ffup 1$ BOND POSTED STATE LICENSE NUMBER EXPIRATI N DATE 20or-Ot"W"Mi '1Wj!200rryW" a I CHECKED —BY I SEPA REVIEW COMPLETE EXEMPT EXP SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED PROPERTY TT#X, -66CC C L �'�Mq 0 1:1 NEW RESIDENTIAL PLUMBING / MECH COMPL ANCE OR 0 ADD!TION XCOMMERCiAl. CHANGE OF USE muLnFAMI 1:1 REMODEL LY SIGN LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) FRONT SIDE REAR ---------- PROPOSED SETBACKS (Fr.) FRONT URSIDE REAR z 2 PARKING RECiD I PR9WED I LOT AREA NNING REVIEWED BY A REPAIR GRADING FENCE CYDS X REMARKS 0 DEMOLISH TANK aGARAGE RETAINING WALL FIRE SPRINKLES CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: i C ECKED BY TYPkOF ION UT OCCUPANT - GROUP NUMBER UM EIR OF CRITICAL C IT SPECIAL INSPECTIOf4 JAREA REQUIRED [] YES OCCUPANT LOAD OF STOR ES ON WESL L N G UNITS AREA', S UM NUMBER DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG 2ta&c JCCLQ AKRI� VALUATION, $ Descrikon FEE Description FEE Plan Check State Surcharge 45 0 HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC :23 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review PERMITAPPUCATION: 180 DAYS PERMIT LIUM 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 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 NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recordillrl Receipt # 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 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTR C- This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLO CALL Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE TE OF WASHINGTON RELATING 0 FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSATID��ANCE . ANF�i 18.27. 0 ICI SIGINATUPE TE SIGNATURE (OWNER 94'AGEbMe' DATE GNED (425) 771-02 OELEkSED BY K" IDATE 1 X ATTENTIdk_::::�'�_ 3 IT IS UNLAWFUL TO I ISE 0 PY A BUILDING OR STRUCTURE UN A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLCW- INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 9 0 M RECORD OF INSPECTIONS 14 ly 4 0%ATE RECEIVED MONDS CITY OF! ED ONSTRUCTION PERMIT APPLICATION JOWNER NAMEINAME OF BUSINESS . . IN - I PERMITEXPIRES USE PERMIT I?M ZONE NUMBERo,- 3, OC/7/v_ JOB SUITE/APT# ADDRESS DrkcrATe, WaQU WL(U-�' J\IOKJ I ADDRE§S ZIP .2�TIE "Uyt C EPHONE L PLAT NAME/SUBDIVISION NO. LOT NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING — PROPOSED REQUIRED DEDICATION— FT LID NO. LID FEE TESCP APProved RW Permit Required Sir at Me Pormth Wd .= Required "Idewalk Required U."... , WWmg required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 ADDRESS CITY ZIP NAME VOOF 00 12Z to 10 ADDRESS .3,q9_5 6 N& st- CITY P ZIP TVWWILA qW16 l?_ STATE LICENSE NUMBER &F-6W OD7& I TELEPHONE NEW 0 RESIDENTIAL ADDITION XCOMMERCIAL REMODEL MULTIFAMILY 11 REPAIR 0 GRADING CYDS DEMOLISH TANK oGARAGE o RETAJNING WALL CARPORT ROCKERY OWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMBER OF OF DWELLING STORIES, DESCRIBE WORK TO BE DONE CBL N Q00'r 01 PLUMBING / MECH COMPLIANCE OR CHANGE OF USE SIGN rn FENCE A L—J X F RE SPRINKLER FIRE ALARM 9r-r-t ckt5r r—cRrriCAL IAREAS NUMBER HEAT SOURCE I GLAZING % I LOT SLOPE % PLAN CHECK NO: I 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 (CUFM. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPUCATION: 150DAYS PERMWILIMM I VEAR - 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 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 CITY'S 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 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE ENGINEERING FIRE REVIEWED BY DATE DATE VARIANCE OR CU SHORELINE OR ADIIII I INSPECTION I BOND REQ'D POSTED Nell f"'r OYES &W $ ' SEPA REVIEW PT I SIGN AREA HEIGHT COMPLETE . EXEM ALLOWED . PROPOSED I ALLOWED . PROPOSED a z LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR PARKING REO'D 1.tAWED LOT AREA 1 .0-1- P NNING REVIEWED X-Ed I I I BY ---p Z/ DATI) I I BY ITYPE OF CONSTRUCTION I CODE SPECIAL INSPECTION REQUIRED [] YES OCCUPANT GROUP OCCUPANT LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION RE(WD k/AT TVA111r.'I I'(1C_1)f]rTV11qD1 Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire,inspbdon Landscape Insp. THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS UC CALL TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPL� IN VIOLATION OF THE LABOR CODE OF THE fIATE OF WASHINGTON RELATINGTO FOR INSPECTION WORKMENS COMPENSATITJUSUI"CE�ANIUACV�18.27. SIGNATURE (OWNER Cef`kq�uEq�-.' ��DATE S NED IA95) arl 0 ?A 771-02 FEE Description FEE State Surcharge City Surcharge Plan Chk. Deposit Receipt # Total Amt. Due JAZPAL-�' I Receipt N APPLICATION This applkatlon Is not a permit until signed by the Building Official or his/her Deputy: and Fees we paWld, and receipt Is acknowledged In space providqd. IGNATU Q.." %CS By AWFUL TO USE OR UPY A BUILDING OR STRUCTU 011 1 RE UNTI INSPECTION HAS BEEN MADE MD APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR OCCUPANCY HAS BEEN G SECTION 109 -OWNER GOLD -ASSESSOR PINK GREEN - ACCOUNTING RD -YOU ARE MAKING 5 COPIES z 0 d 0 ITI M M 0 80 C M ITI z 0 T! M M 11:3 VS 0 G M C.) z z z 0 M