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20030987.pdfI DATE RECEIVED PERMIT EXPIRES A? CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION USE PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS OWNER NAME/NAME OF BUSINESS d " PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ I MAILING DRESS W1 U2 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING - PROPOSED REQUIRED DEDICATION- FT TESCP Approved RW Permit Required St.. Use Permit Raqd Inspection Required Sidewalk Required Undartiround Witing required CITY ZIP Cori vik TELEPHONE NAME _10� aa k4- ta ga!a r, vi- ge-0 oil METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 z 15 ADORE ss L 1.23 CLOII? " .. REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z z I I CITY ZIP — TELEPHONE NAME COL ENGINEERING REVIEWED BY DATE ADDRESS 57'f t_ W, 2o) i FIRE REVIEWED BY DATE lu IM, CITY ZIP a~ TELEPHONE �tZg 7 3 9 STATE LICENSE NUMBER EXPIRATION D TE ,Tru A cpLi on 9%%W 12- CHECKED BY VA-RIANCE OR CU SHORELINE OR ADB# . . - INSPECTION REQ'D 13YEs 13NO BOND POSTED $ z 9 06 PR OPERTY TAX ACCOUNT PARCEL NO. SEPA REVIEW COMPLETE , EXEMPT EXP S ION AREA ALLOWED , PROPOSED HEIGHT ALLOWED PROPOSED NEW 1:1 RESIDENTIAL PLUMBING/MECH ADDITION COMPLIANCE OR 91 COMMERCIAL CHANGE OF USE QREMODEL 0 MULTIFAMILY SIGN REPAIR GRADING CYDS FENCE X FT) E] DEMOLISH TANK OTHER WAGE RETAINING WALL 0 F RE SPRINKLER CARPORT ROCKERY FIRE ALARM LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (Fr.) FRONT SIDE REAR PROPOSED SETBACKS (Fr.) FRONT L/R SIDE REAR PARKING REOID I PROVIDED LOT AREA PLANNING REVIEWED BY DATE REMARKS frYPE OF USE USINESS OR ACTIV" EXPLAIN: �; 6— 'r 25!�� CHECKED BY TYPE OF CONSTRUCTION COPE dv- OCCUPANT GROUP S 5 NUMBER OF STORIES NUMBER OF DWELL NG UNITS CRITICAL AREAS NUMBER SPECIAL INSPECTION JAREA, REQUIRED 0 YES OCCUPANT LOAD 6 Dt9CRIBE WOR9 TO BE DO kp-.n3 ewt a via —_ - REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D hnr,�A AcU $ 0-1-11 lot �6 No WJ ub Description FEE Description FEE U-,7 qjO Plan Check State Surcharge EAT SOURCE "M % LOf SLOFq % Building Permit C'T] City Surcharge AN CHECK NO: 6;345z4 I VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORUES 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 SEPARATE PERMISSION. Grading Engr. Review PFRMITAPPUCATION: 160 DAYS PERMIT UMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 100 DAYS SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS N INTEREST. AGREES TO INDEMN117X 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 HE 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." Fire Review PlanChk.Deposft Fire Inspection 50 Receipt # Landscapelnsp. Total Amt. Due f) Receipt # - :.;9 ewe Recording Fee I 1 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 WORKNIEN'S COMPENSATI��RANCE AND RCW 18,27. CALL FOR INSPECTION (A-05) _V16 771-0220 EXT 1 3 APPLICATION APPROVAL This application Is not a permit until signed by the Building Official or his/her Deputy: and Foos are paid, and receipt Is acknowledged in space provided. OFFICIALS SIGNATURE DATE /20 -R. ------ _. __ SIGNATURE (OWNFA 0 AGE" DATE SIGNED %TTENTI9W'_ DATE VT1 11 // - - - I . - , IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW -IN CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -AS! 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 0 M M M -4 ic M M C CO) 0 _n .M M M a (M) 0 0 Rn a 0) ic 0) M C) z 0 M a FINAL PROJECT APPROVAL FORM FAILED FINAL INSPECTION - OUTSTANDING ISSUES El Copy of CORRECTION NOTICE given to owner/cbntractor by inpector 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Signature l:temp:bldg:fonns:ocaprvl 3/25/04 Z. 0 I CITY OF EDMONDS CONSTRUCTIONPERMIT APPLICATION OWNER NAMEINA BUSIN SS X�.A LAX4 fk� - MAILING ADDRESS )SIO 5W -,, CITY ZIP TELEPHONE 4\j I! woo od L66 7?v NAME ADDRESS VF awe CITY ZIP ITELEPHONE ADDRESS CITY wymon, STATE LICENSE NI PROP NEW 0 ADDITION " REMODEL 0 REPAIR 0 DEMOLISH 0 GARAGE CARPORT OWE Of USEjI 14UMBER OF ILaTORIES P jF '. "I "U 1 :4 ;2a I ZIP I TELEPHONE 420.2 01 92f 7 -7.7 EXPIRATION DATE :0, 'Ll I;z- PARCEL NO. 10.1 PERMIT EXPIRES USE PERMIT ZONE NUMBER405-,22e_ JOB ADDRESS SUITE/APT# PLAT NAME/SUBDIVISIO 77 T NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP ��PrGvOd RW Permit Required Street Use Permit RocVd EXISTING — PROPOSED— Inspection Required Sidews& Required REQUIRED DEDICATION— FT UnderWound 13 METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED I I YES NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE BY DATE FIRE REVIEWED BY DATE / �, Z_ C) - 0—? 77 1V VARIANCE OR CU V S HORELINE OR ADB# INSPECTION BOND CHIEC REO'D 113YEs POSTE 2 ONOIS 4:1a SEPA REVIEW SIGN AREA HEIGHT !COMPLETE. EXEMPT I ALLOWED . PROPOSED I At I OWED . PROPOSED RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) SIDE REAR PROPOSED SETBACKS (Fr.) FRONT LIR SIDE REAR .0 ALLOWED PROPOSED FRONT COMMERCIAL COMPLIANCE OR CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE muLnFAmiLy SIGN RECID I PROVIDED I GRADING FENCE CYDS ( x FT) REMARKS 0,: OTHER I NALL 13 FIRE SPRINKLER FIRE ALARM NESS OR ACTIV" EXPLAIN: NUMBER OF CRITICAL DWELLING AREAS UNITS NUMBER ut: UUNF a I Al Restrilvia U44 A AL No b k I if- 'a a..,, f gw & ( k." SOURCE q"G % LOT SLOFT % VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTV ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVIEWAYS. MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT ILIUM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION CHECKED BY ITYPE OF CONSTRUCTION CODE OCCUPANT GROUP SPECIAL INSPECTION REQUIRED JAR;E� OCCUPANT LOAD [] YES REMARKS PROGRESS INSPECTION6 PER UBC 108/FINAL INSPECTION REG'D VALUATION" s f--% f 5'D Description FEE Description FEE Plan Check State Surcharge cz Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS A P P Fire Review Plan Chk. Deposit IN INTEREST. AGREES TO )NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF N I N EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND E' M Fire Inspection Receipt It ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY F FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE R 0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE D E E k Landscapelnsp.' Util Total Amt. Due NOR LIMIT IN ANY WAY THE Cnya ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- N 0 R /,3 Adz Recording Fee Receipt # I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION HERE APPUCATION APPROVAL GIVEN 'IS CORRECT: AND THAT I AM THE OWNER. ORTHE DULY AUTHORIZED AGENT OF G tVEN T THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- H E 0 WI CALL This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED TiON. A" IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO IN VI OU FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and receipt Is acknovAtidged in space provided. WORKMEN$ COMP EN CE AND RCVV 18.27. i OFFICIALS SIGNATURE DATE G TU BIG NATURE (9NqAR DATE SIGNED (425) -19 ? !O�A.GEN`Ti 771-0220 4eo R DATE ,",A ENT19W M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YEU.TOVN - ISN� �EC1 CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 A ESSC PINK - OWNER - GOLD - AS ESSOR��/111, /02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING a