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20030995.pdfa 1 DATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS TI � wex -Lim C_-)0o4_i)rI*ey\A 5. MAILING ADDRESS P CITY ZIP TELEPHONE CFIS- qkiz.56 I W,5- L�01-34� NAME ;DD—RESS CITY ZIP ITELEPHONE NAME �'�IMAANNlj ADDRESIL 41a f?T CITY I Umnacd clkz,p STATE (OENSE NUMBER PROPERTY TAX ACCOUNT PARCEL NO. CBL 0 ') 1 'A�d TELEPHONE —dH—E—CKED BY EXPIRATION DATE W 11 ) 014 NEW RESIDENTIAL PLUM ADDITION ;9—CO MMERCLAL COMP CHAN 1:1 REMODEL 0 MULnFAMILY �kSIGN 0 REPAIR [3 GRADING CYDS FENCI 0 DEMOLISH 1:3 TANK OTHE oGARAGE [:] RETAINING WALL 0 FIRE S CARPORT ROCKERY FIRE ME OF USE. BUSINESS OR ACTlVi1TY) EXPLAIN: 4& NUMBER - - NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITE NUMBER DESCRIBE WORK TO BE DONE PERMIT EXPIRES USE PERMIT ZONE I NUMBER r 00?:1 JOB S 0 ADDRESb�(,Q��/ zz PLAT NAMF/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Perndt Required Street Use permit Req'd EXISTING — PROPOSED Inspection Requited Sidewslit Required REQUIRED DEDICATION— FT Underground Witing required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES 13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE REVIEWED BY DATE FIRE REVIEWED BY DATE I -. Ir VARIANCE OR CU SHORELINE OR ADB#. INSPE, 'ON 7D BOND E I POSTED S $ SEPA REVIEW SIGN AREA �'- HEIGHT COMPLETE EXE MPT ALLOWED PROPOSED ALLOWED PROPOSED EXP /� �_jq,' SING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) LIANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRPNT— LIRSPE REAR GE OF USE z I PARKING LOT AREA PLANNING REVIEWED. 'BY DATE i I X—FT) REMARKS R PRINKLER ALARM r— 14EAT SOURCE GLAZING % I I LOT SLOPE % PLAN CHEC VESTED DATE THIS PERfArr AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK -to BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBIS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT IJMrP 1 YEAR - PROVIDED WORK 18 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 rOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMff. 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 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 EMPLOYED IN VIOLATION F TH LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S CO I INSURANCE AND RCW 18.27. SIGNATURE nR&4E DATE SIGNED �N 0 /1) CHECKED 13Y JTY;��ION COU. OCCUPANT q21 GROUP M $PECI,11L INSPECTION JAREA OCCUPANT REQUIRED [:] YES LOAD REMARKS 1PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REO'D IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U%lL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIN CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD -YOU AR VALUATION Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscapeinsp. Recording Fee ," CALL 1R INSPECTI, ( 0110% 425; 771-0220 EXT 1334 FEE Description FEE State Surcharge �Q — �n I City Surcharge joe�' Plan Chk. Deposit Receipt # Total Amt. Due Receipt APPLICATION APPROVAL This applIcation Is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid, and receipt Is acknowledged in space provided. FyQALS SIGNATURE DATE OR:GINAL-FILE YELLOW- INSFf.CTC PNK-OWNER GOLD -ASSESSOR GREEN - ACCOUNTING z 0 1 0 m =1 --fi m c Ma 0 80 c ic MM mz 10-4 CE 0 -n n m M a 0 0 M C (J) c V) M 0 Z z z 9 0 m OUTSTANDING ISSUES -,GRAN"r YNAL r'(-vjz%" Aftrrx%.%j v t%'u RE si Date ocaprvl.doc.l:teinp:bldg:formsIO/OI 0 4s I.J �z�JN� 44A -4, -7 77 DATE RECEIVED 0 PERMIT EXPIRES use PERMIT ZONE CITY OF EDMONDS NUMBER JOB APT# CONSTRUCTION PERMIT APPLICATION �DDREsb� c� S U� OWNER NAMERME OF BUSINESS PLAT NAME/SUBDIVISION NO. NO. LID NO. Y\ A 5, F-7 I I 11 ........ MAILING ADDRESS "I — LID FEE $ TESCF Approved PUBLIC RIGHT WAY PER OFFICIAL STREET MAP RW Porm" Required 1911�0 bsik PL h r_- Street Use Peffnh Wd CITY ZIP TELEPHONE EXISTING PROPOSED k*pwlon Required I Sklawatk Raquirod REQUIRED DEDICATION_'FT underground VI:nmc)(6 qsbz�5.1 Wiring required 13 NAME METER SIZE 'LINE SIZE NO. OF FIXTURES PRV REQUIRED YES13 NO ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE CITY ZIP TELEPHONE BL NA ME )N ENGINEERINP REVIEWED BY DATE A�ESB z 0, q FIRE REVIE%*D BY DATE CrW AIP ITELEPHONE 0 VARIANCE OR cu SHORELINE OR ADBO INSPECTION BOND urATEQgaisENUMBER EXPIRATION DATE I CHE KED BY ECI'D POSTED =��s ONO $ 01 IL'IlIQ SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMP ALLOWED PROPOSED ALLOWED PROPOSED M Oaf Z& wja2ga� EXP I /y C LOT COVERAGE REQUAD SETBACKS (FT) PROPOSED SETBACKS (FT) M_ NEW 0 RESIDENTIAL 0 PLUMBING�MECH ALLOWED PROPOSED FRONT SIDE REAR UR SiM REAR �41 1 0 C COMPLIANCE OR [3 ADbITION MMERCLAL CHANGE OF USE ;E�_Co PARKING r AREA PLANNING REVIEWE A - 0 BY DATE IL REMODEL 1:3 MULTIFAMILY SIGN REO`D 10 GRADING FENCE z REPAI FT) REMARKS R CYL)s 0 X 7. OTHER ;DWOLISk TANK NKLER �,GARAGE RETAININGWALL o. FIRE SPRI' O"n CARPORT ROCKERY FIRE ALARM (TYPE OF US BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE 0!_TN ON COOE OCCUPANT yn GROUP� ITI M _9TRU I_q2 1.� NUMBER ER OF CRITICAL 'LLING AREAS SPECIAL INSPECTION JAREA OCCUPANT OF LOAD UOITS NUMBER REOUIRED _ITORIES C: DESCRIBE WORK TO BE DONE REMARKS 01 PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE= VALUATION Ing MW co FEE Description FEE Description State Surcharge Plan Check 4 0 HEAT SOURCE 'Ot-SLOPE % Surcharge M GLAZING % ..-.;.L city I Wy Building Permit Qu I -oa:::4 6�p — I ( PLAN CHECK �� VESTEd DATE I Plumbing Mechanical THIS PFjWIT AUTHORIZES ONLY THE WORK NOTED. THIS PEFMrr COVERS WORK TO 1: BE DONE ON PRIVATE PROPERTY ONLZ ANY CONSTRUCTION ON THE PUBLIC Grading IE :I DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, uARauEEs, ETC.) unt.11- REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPLICATION: 180 DAYS PERMIT ILIMM I VEAR - PROVIDED WORK IS STARTED WITHIN 180'DAYS Engr. Inspection SEE BACK OF PINK PERfArr FOR HORE INFORMATION -APPLICANT.ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCOESORS Fire Review.,,. IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OR- - EDMONDS. WASHINGTON, IT$ OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND. �lrii InspecU.-o-in, ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY 1 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR UMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Recording Fee 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 CONSMUC- L TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPUDYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO OR INSPECT11 WORNMENG C��URANCE AND RCW 18.27. SIGNATURE �= 14�11 DATE SIGNED (4-25) (4 /.�o 1 7 -0 0 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U IL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI �1-. CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 04/02 PRESS HARD -YOU ARE, Plan Chk. Deposit Receipt # Total Amt. Due —A I Receipt # APPUCATION APPROVAL This aWication is not a permit unul signed by the euudlno Official or his/her Deputy: and Fees are paid, and receipt is acknovirledged In space provided. OFYQIALS SIGNATURE DATE M 133 a k)� ORIGINAL - FILE YELLOW - INSIkCTOR� PINK -OWNER GOLD -ASSESSOR A 'G 5 CO GREEN ACCOUNTING KAG 5 CO ES