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20030986.pdf1(41W11 x4fX11— 19 DATE RECEIVED IMINNION . m — CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS /0,1&k 7/laAn ITo MAILING ADJI�tSS _11P_3 _ZV . IV. CITY ZIP TELEPHONE NAME ADDRESS ::2t_ (-,2— e /V CITY zip 2jjAat77 TELEPHONE NAME 24uire Its INC. CBLIV ADDRESS Oa 7A IV 3 2 1 4dllj_ CITY �(-a LICENSE NUMBER ZIP TELEPHONE P6 NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY 0 REPAIR GRADING CYDS DEMOLISH TANK GARAGE 0 RETAININGWALL CARPORT ROCKERY (ME OF USE, BUSINESS OR ACTIVITY) EXPLAIN: le"&WWut NUMBER OF STORIES NUMBER OF DWELLING I UNITS DESCRIBE WORK TO BE DONE jo PERMIT EXPIRES r US E ��rts PERMIT ZONE MBER JOB ADDRESS _q SUITE/APT# q L ,� PLAT NAME/SUBDIVISION NO. LbT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP App"road RW PerrrA RequIred Street Use Ps=4 Floq'd EXISTING — PROPOSED Inspectlo" Required Sidawalk R@WIr6d REQUIRED DEDICATION— FT Underground WkIng roquired 13 METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED YES[3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING REVIEWED DATE FIRE REVIEWED BY DATE W 1z cc tA71ON D TE C VARIANCE OR CU SHORELI!!!�q INSPE ION BOND RE qD POSTED 1$ E3v AD SEPA REVIEW SIGN AREA HEIGHT COMPLtit EXEMPT I ALLOWED PROPOSED , ALLOWED PROPOSED 14—_ ?5 EXP LOT COVERAGE REQUIRED SETBACKS (FT.). PROPOSED SETBACKS (Fr.) PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR OR NO -- /Va z oCOMPLIANCE CHANGE OF USE I 61', A. 0 PARKING RECID PROVIDED LOT AREA PLANNING REVIEWED 13Y DATE SIGN We FENCE X FT) REMARKS E FIRESPRINKLER FIRE ALARM CRITICAL AREAS NUMBER If I 71/P I HEAT SOUR� GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN jCURBS, SIDEWAU(S, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT LIMM I YEAR - 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 CITYS 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 EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSAT!�J"RANCE AND RCW 18.27. SIGNATURE (OWNER 0 IATE SIGNP t!�L I c /�,� / <77 0 3/ ATTENTION I 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 CHECKED BY jj!WN OCCUPAN%,qA GROUP nram SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [3 YES LOAD REktARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECVD 04/02 PRESS HARD -YOU AR VALUATION $ Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical IZZ/ Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due �7 Recor ng Receipt # APPLICATION APPROVAI CALL This application Is not a permit until Signed by the �014 Building Official or his/her Deputy: and Fees are paid, and INSPECTION receipt Is acknowledged In space provided. (425) LS SIGNATURE DATE // z It 771-0220 - / I! E 091333 MAI) k, - ill 10V; ORIGINAL - FILE YELLOW - INSPECTOR 61 PINK -OWNER GOLD -ASSESSOR ra��71NG 5 COPIES GREEN - ACCOUNTING z 0 1 0 :; 9 V5 -4 am c rn 0 -10 0 m m z IC) CO) 0 m m 0 0 0 M C 0) M V) M 0 Z ;u z z 0 m all.ATERECEIVED ?400rl� 1601ar 149 CITY OF EDMONDS -CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS 7-�., 1,ra MAILING AD�YSS r 1<93 7.n _,4tW&-rA_ /V - CITY ZIP ITELEPHONE Sqz-a - 1 - sA �e o 6 -73 t- 7 AP.? NAME ADDRESS "A- /y yj -z- CITY ZIP ITELEPHONE i4A e-? 0� 77 1:24 1 - 4� 17� 610 001 NAME CBL# j IAIC ADDRESS 0 CITY / W 3 2 17d% ZIP TELEPHONE svA -2od- w"7-,4eo� STATE LICENSE NUMBER EXPI11ATION *TE I CUW_X8__M 4!9A PROPERTYJAX- ACCOU NEW RESIDENTIAL ADDITION COMMERCIAL TIFAMILY REMODEL MUL REPAIR GRADING CYDS DEMO'LIS11 0 TANK GARAGE" RETAININGWALL CARPORT ROCKERY (ME OF USE. BUSINESS OR ACTIVITY) EXPLAIN: I N NUMBER UMBER OF OF DWELLING A A— STORIES UNITS DESCRIBE WORK TO'BE DONE 7' 11 PLUMBING / MECH COMPLIANCE OR 0 CHANGE OF USE [3 SIGN, oFENCE — X—FTi ER FIRE SPRINKLER FIRE ALARM CRITICAL AREAS Al� NUMBER r VF I MAC 0 �PERMITEXCPIRES USE PERMIT ZONE L NUMBER JOB SUITE1APT# ADDRESS qq PLAT NAME/SUDDMSION NO. LFT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESGr AP FRIW PerwA R*�W od so" Us* Pe t PAId EXISTING — PROPOSED impwtion Requtred skkwak Requkw REQUIRED DEDICATION— Fr Ur4arW-W Widng r*qWW 13 METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED I YESO NO 13 REMARKS OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE REVIEWED BY DATE FIRE REVIEWED BY DATE U3 X IE VARIANCE OR CU SHORELINE O!��,31NSPE&ION BOND R E Q& POSTED YES 'AXWO ----------- SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED .,PROPOSED L ?51' =XP 1 LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACK$ (Fr) ALLOWED PR POSED FRONT SIDE REAR FRONT UR SIDE REAR Aa &—a 6A ovl- PARKING LOT AREA PLANNING REVIEWED BY DATE IV RECYD I PROVIDED 06 jwckf REMARKS CHECKED 13Y OCCUPANT GR SPECIAL INSPECTION AREA OCCUPANT REQUIRED [j YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOtDL Description FEE Plan Check M J; HEAT SOURCE LAZING % LOT SLOPE % Building Permit City Surcharge 4� PLAN CHECK NO: VESTED DATE Plumbing Mechanical TN8 PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONILX AM CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MMUEES, ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. Engr. Review PER11111TAPPLICATIOlt 190 DAYS PERMIT LIMM I YEAR - PROVIDED WORK 19 STARTED WMIN 180 DAYS Engr. Inspection I SEE BACK OF PINK PERMIT FOR MORE INFORNIATION .;A ON BEKkF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS. Fire Review Plan Chk. Depwk PP N IXVRWEir, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY dF 1. V . EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLJOYEES, AND AGENTS FROM t�WYMO Fire Inspection . SX2 1-7 Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Tote . I Amt. Due NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording5pa-_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION. 'N APPUCATION APPRO IS CORRECT, AND THAT I ALI THE OWNER, OR THE DULY AUTHORIZED AGENT 01 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS . TRU�� n Is not a permit unfit signed by the GIVEN C .. CALL This applicatilo TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED BuIlding OMeW cr hIs1her Deputy: and Fees are paid, cnd L_ IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FORINSPECTION receipt 13 acknovAedgod In space provided. y the uIldl WORKMEN$ COMPENSATqj"RANCE AND RCW 10.27. ICIA DATE DATE SIGNP 142 kOFICIALS SIGNATURE SIGNATURE (OWNER 0 5) 7 71-0220 lYr�l _&LEASEP BY ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U IL �L A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI ORIGINAL - FILE YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU AR ING 5 COPIES GREEN - ACCOUNTING Description FEE State Sumharge