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20030977.pdf4 DATE RECEIVED // (a IT EXPIRES Ma CITY OF EDMONDS USE PERMIT ZONE NUMBER,_, CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# OWNPNAME/NAME OF BUSINESS ADDRESSq3/,�, a:aj t !� PLAT NAME/SUBDIVISION NO, LOT NO. LID NO. MAILING ADDRESS LID FEE S PUBLIC RIGHT TESCP Approved OF WAY PER OFFICIAL STREET MAP RW PennittRequiro.d 't= CITY ZIP TELEPHONE Street Use Permit Req'd EXISTING — PROPOSED inspection R -ad 9,Y b 2, Sidewalk REQUIRED DEDICATION— FT underground j2 Wiring required NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I I YES13 NO C3 2 ADDRESS REMARKS C3 OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE CITY ZIP NAME CBL# 1AA4 0 -S 0 ADDRESS ENGINEERING REVIEWED BY DATE _rI514 Pk - "I M R't I IaPW4,' P_ 27-6 �0 Ic r6 FIRE REVIEWED BY CITY ZIP TELEPHONE DATE —ADB# SLATE LICENSE NUMIER EXPIIIN DATE I,�CHECKED 9 VARIANCE OR CU SHORELINCOR INSPECTION BOND REO'D POSTED 113YEs 13NOj$ PROPfR`rYTAX ACC NT CEL NO V (2��'C51*08:y no= LAD SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED P ROPOSED EXP NEW RESIDENT'IAL PLUMBING / MECH LOT COVERAGE REQUIRED SET13ACKS (Fr) PROPOSED SETBACKS (Fr.) ALLOWED COMPUANCEOR PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR ADDITION COMMERCIAL CHANGE OF USE 0 REMODEL MULTIFAMILY SIGN PARKING LOT AREA PLANNING REVIEWED BY DATE REOD PROVIDED __j REPAIR 0 GRADING FENCE CYDS I X—FT) REMARKS OTHER 0 DEMOLISH TANK oGARAGE RETAININGWAILL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM ME OF USE, BUSINESRACTlVffV) E)V"N- CHECKED BY PE �QU Q C OCCUPANT GROUP 7 f,11 NUMBER NUMBER OF RrrICAL OF DWELLING AREAS STORIES FUNITS SPECIAL INSPE 115N AREA OCCUPANT N REQUIRED [] Y S LUAU DESCRIBE WORK TO BE DONE REMARKS 71v::�f4lL W?08P:5f,._)0L PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REG'D Dill tv 0 00 4 A.) 37�, 9,44 L LeP I VALUAMON T $ Description FEE Description FEE Plan Check State Surcharge 1 S JRCE f ? GLAZING % LOT SLOPE % Building Permit !104 1 7�� City Surcharge is f"Culk NU: VESTED DATE Plumbing f �4 .LdQ: THIS PERMIT AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading t: SEPARATE PERMISSION. Engr. Review PERMIT APPILICATION: 180 DAYS PERMIT UMrr 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 C Ty OF EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt # 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. - I Recording Be 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 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC' APPLICATION APPROVAL TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED This application Is not a permit until signed by the IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S CqMPENSATION INSURANCE AND FICA! 18.27. F R INSPEC ON receipt Is acknowledged In space provided. ;CJALL Building Official or his/her Deputy: and Fees are paid, and SP al R R OR AGENT) DATE SIGNED OFFICIALS SIGNATURE IJT�]O__7 (425) 771-0220 ATTENTION IS Y JATE M 1333 'r 1-2- DI (IF. - IT UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL FINAL V 1- A INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- q> f.)` CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 WIGINAL - FILE YELLOW - INSPECTOR rd F,;�/11_7 Vj: tv r(( 04/02 PRESS HARD -YOU ARE -OVER GOLD -ASSESSOR MAKING 5 COPIES -Wqp-ACCOUNTING z 0 :1 0 M =i :_n ra 3� 0 M C M -4 § 0 C: � z M 10 � z 4 0 _n '3n� I M M Fn 0 z z 0 :d 0 IT! FLUE� CHIMNEY AND EQUIPMENT INSPECTION CHECKLIST FOR WOODSTOVE PERAUTS Each year before a stove or fireplace is put into service t6 chimney flue should be thoroughly cleaned e s g of soot and other residues. Prior to installation of a certified solid fuel burning appliance in an xi tin ed masonry chimney, the following items must be inspected by the owner. This form must be complet to the Building*Division with the Woodstove permit application. and submitted 1. CHIMMY LINING: Is the chimney lined with fireclay flue tile, firebrick or other approved lining? Yes NO Is the lining in good condition? No voids, cracks or deterioration? Yes yl/ No- 2. CLEARANCE TO COMBUST113LES: -aning members, a minimum of I" away from the Are all combustible materials, i.e., wood fi chimney walls? Yes No 3. GENERAL CONDITIONS: is the exterior masonry in good condition, free of cracked or broken liners, rotten mortar joints or structural defects? 'No Yes t,"' 4. EQUIPMENT: turers instructions for the equipment installation and is the existing Have you read the manufac chimney compatible for installation? N Yes, 01 I hereby acknowledge that I have read these inspection requirements; have personally. inspected the th ul th ri ed that the information given is true and accurate; that I am the owner or e d y au o z chimney, agent of the owner. D Signatut(�� CHIMNEY SAFETY: Please observe the following warnings in order to install and use solid fuel burning equipment. 1. Use all appliances in the precise manner described and tested by the manufacturer. 2. Follow listing instructions for clearances to combustibles. or needed repairs. 3. Inspect chimney flues and appliances yearly f 1911 immediately. 4. If creosote accumulates in the flue and starts to bum cal 5. Keep an extinguisher on hand and make sure all your smoke detectors work. DEC 1 2003 "ERA41T COUWER L-Tenip:Building:Handout.Wdstveho-6/03 J. ' -— -- ---- .�—'~---------����`_�—~�r,--` ^ K ! i !}� � � � ^ ' __—_` I DATE RECEIVED USE CITY OF EDMONDS ZONE PERMIT EXPIRES (AL-1 PERMIT NUMBER CONSTRUCTION PERMIT A LICATION- JOB ADDRESS17,5/1, surrE/APIP OWN NAME/NAME OF BUSINESS PLAT NAME/SUBDIVISION No. LOT NO. LID NO. LID FEE S MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING — PROPOSED REQUIRED DEDICATION— FT TESCP AP ;;;(] RW Perwift7Required Street Use Penn" RW Inspectlon FlaquWed Sldews* Required Undergmund Voing feciukod CITY ZIP TELEPHONE 10I ,f__7�5rd (0 1?4( ADDRESS CITY ZIP NAME CBLN )hA ve 0 ADDRESS /09.2�j CITY f ZIP TELEPHONE MU eltrc-o SUTE LICENSE NUM EXPIR ATE )TN L—,CHECKED BY ) eq -tEfflme+ DI - I %W44-1- , a . METER SIZE LINE SIZE I W. OF FIXTURES PRV REQUIRED 0 YES [3 NO 13 z REMARKS i" OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE REVIEWED BY DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINEORAD1311 I INSPECTION BOND REQ'D POSTED SEPA REVIEW SIGN AREA OYES; 13NO I $ HEIGHT COMPLETE - EXEMPT I ALLOWED . PROPOSED I ALLOWED . PROPOSED A. NEW PC RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR AIPITION [j COMMERCIAL COMPLIANCE OR CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE REMODEL MULTIFAMILY SIGN REQ`D PROVIDED I GRADING FENCE REPAIR CYDS X_ FT) REMARKS OTHER 0 DEMOLISH TANK 0 [3 GARAGE [j RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIREALARMI. �,PW.90F,IJSE.BU$iNE87A(;T[VffY)�.� CHECKED BY TYPE OF CO UCTiON CODE OCCUPANT GROUP NUMBER NUMBER OF CRITICAL OF - DWELLING AREAS 7.- I'LINITS SPECIAL INSPECTION JAREA OCCUPANT LOAD STORIES NUMBER REQUIRED [3YES DESCRI13E WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL.INSPECTION REaD C W,0 5tV OJL D/,V1' z 0 A",,. 37� qt.4 L Lot--" VALUATION $ Description FEE Description FEE Plan Check i State Surcharge HEAT;WRCE GLAZINGt LOT SLOPE % Building Permit q1ty Surcharge PLXN CHECK NO: VESTED DATE 66 � Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO h BE DONE ON PIWATE PROPEM ONLX ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CUMM, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMffAPPUCATION: IGO DAYS PERMfT IUMM I YEAR - PROVIDED WORK IS STARTED WITHIN,- ISO DAYS ;. Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION . Plan Chk. Deposit '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 Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Total Amt. Due FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapoinsp. DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE CfTY`8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Receipt # NOR LIMIT IN ANY WAY THE Recording Fee I HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APPLICATION: THAT THE INFORMATION GIVEN IS CORRECr, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL — A . . —4 h th. THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- A '"'s apI.— n a n- a permt unt Own y TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED C L Building Official or histhet Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO F�R INSPEC ON receipt Is acknowledged In space provided. WORKMEWS C OFFICIALS SIGNATURE DATE ,%J�ENSATION INSURANCE AND RCW 18.27. SIG OR OR A�ENT) DATE SIGNED 1A912% NAT .103 M I / &AA-- 771-0220 OATE I ATTENTION BT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL d A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- (V IV VWIGINAL -FILE - YELLOW- INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 (;-ow - ER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES `61V1QP_ ACCOUNTING Z, 0 M M c C M C M M 0 _n n M M Fn C z 1711