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20030997.pdf4 elmk - DATE RECEIVED PERMIT EXPIRES USE PERMIT CITY OF EDMONDS ZONE NUMBER j)& CONSTRUCTION PERMIT APPLICATION JOB UITE/APT# ADDRESS S OWIS NAMEINAME OF�&NESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 5 MAILING ADIRESS LID FEE $ 7ESCP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Parrml Requited CITY ZIP TELEPHONE Street Use Pernnil Req'd EXISTING - PROPOSED Inspection Requited Sidewalk Required 1"�)to�ro L.." I>r REQUIRED DEDICATION- FT Underground wiring required NAME METER SIZE LINE S�� FIXTURES PRV REQUIRED YEs13 NO 13 9 ADDRESS REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP =ONE NAME L 0 ENGINEERI NG REVIEWED BY DATE - 0 kADDRESS us FIRE REVIEWED BY DATE CITY ZIP TELEPHONE cc rL 0 U VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED 10YEs E3NOj$ SEPA REVIEW SIGN AREA HEIGHT PROPERM TAX ACCOUNT PA�R�.NO. PROPOSED.,. OWED PR COM OPOSED PLETE EXEMPT ALLOWED 00q _77 �_:) 16100U, DO , _�d EXP NEW 1:1 PLUMBING I MECH ayROE'SIDENTIAL LOT COVERAGE REQUIRED SETBACKS (F0' %1PROPOSED SETBACKS (Fr) ALLOWED PROPOSED FRONT SIDE REAR I`Rq�T URSIDE REAR COMPLIANCE OR ADDITION COMMERCIAL 1:1 CHANGE OF USE z REMODEL MULTIFAMILY [3 SIGN PARKING LOT AREA PLANNIN13 REVIEWED 13Y DATE REQ*D I PROVIDED 06 [3 FENCE Ea1R'EPAIF1 GRADING CYDS X 177) REMARKS DEMOLISH TANK OTHER oGARAGE RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY FIREALARM OWE OF USE. BUSIN EXPLAIN: CHECKED BY TRUCTION OCCUPANT TYPE OF C N M GROU NU BER 4UMBER OF CRITICAL N OFM DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT LOAD STORIES UNITS NUMBER REQUIRED S DESCRIBE WORK TO BE DONE REMARKS z PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D 12d eL Oyf,+-- _L VALUATION ML44 $ DescriptIon fEE L) rDescripotion FEI! Plan Check State Surcharge Stz HEAT SOURCE GLAZING % LOT SLOPE % Buildi6g* Perm City Surcharge 15 PLAN CHECK NO: VESTED DATE Plumbing Base Fee Mechanical THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC Grading 2 UOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. 1: Engr. Review f5 PERMIT APPUCATION: 1180DAYS PERMrr UMrP 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 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt # IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due 9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE as 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." zi Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL 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- CALL This application Is not a pennit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED uIlding Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO R INSPECTIO receipt Is acknowledged In space provided. WORKMEN'S C2!!!nION INSURANCE AND RCW 18,27. ATURE DATE1 SIG (OWNE 014 AGENT) le/7' DATE SIGNED (425) 4� 771-0220 vt BY- DfTE EfITION EXT 13 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW. INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES p r DATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION NAME/NAME OF7NESS ING ADyfiESS 7;_ ZIP TELEPHONE �Iq- 2- NAME ADDRESS CITY ZIP TELEPHONE NAME 412�e2k)j5_7e_ ADDRESS CITY zip TELEPHONE STATE LICENSE NUMBER IROPER,IX TAX ACCOUNT PARS,gl. NO. 00�L_1:� 5 OM2 Cj NEW [P-1ESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY awEPAIR 0 GRADING CYDS DEMOLISH TANK GARAGE RETAINING WALL CARPORT ROCKERY (TYPE OF USE, BUSINE ACTIV EXPLAIN: NUMBER NUMBER OF OF 2.1 D!�LING I STORIES .. DESCRIBE WORK TO BE DONE A 6- 1 x CBL # PERMIT EXPIRES now� USE PERMIT :� ZONE NUMBER 0"/67' JOB C� 1UITE/APT# ADDRESS PLAT NAME/SUBDIVISION NO, LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Parn.4 Required Street Use Permit FMqV EXISTING — PROPOSED Impaction Required Sidewalk Required REQUIRED DEDICATION— FT I Underground 1 womg required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO C3 I REMARKS OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE I N! rL VARIANCE OR CU SHORELINEORADB# I INSPECTION BOND 1710�DATE I CHECKEDBY REQ'D POSTED I 13YES 13NO $ SEPA REVIEW SIGN AREA HEIGHT Wo COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED EXP PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) COMPLIANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRONT IJRSIDE RE%R CHANGE OF USE I I V X A 0 P .F S A P E L LOT ALLOWE PARKING A LOT AREA PLANNING REVIEWED BY DATE SIGN Am FENCE REO'D PROVI n1fi raft R M X IFT)REMARKS OTHER tons k F RE SPRINKLER FIRE ALARM CHECKED BY OF CONSTRUCTION CODE OCCUPANT ITYPE GROUP CRITIC AL AREAS SPECIAL INSPECT1075E7 OCCUPANT A- N NUMBER REOUIRED LOAD YES REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D -is-- rf I %A C 1A(' /- 911 HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: 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 (CURBS. SIDEWALKS. DFINEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180DAYS PERMIT UMM I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIF% 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 PERMrr. 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 HERE13Y 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 COMPIY 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 CqyFffFMqI0N INSURANCE AND RCW 18.27. SIGNA'nJg0WNER, AGENT]i" DATE SIGNED VALUATION Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscapelnsp. Recording Fee IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL\ A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF!' , CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 09/03 PRESS HARD -YOU ARE / CALL R INSPECTION 1A95) 771-0220 EXT a FEE State Surcharge City Surcharge Base Fee Plan Chk. Deposit Receipt # Total Amt. Due 0 1 - — 9-- I Receipt # lo) APPLICATION APPROVAL This application Is not a permit unw signed by tho cOng Official or his/her Deputy: and roes are paid, and f0wlPt 19 acknowAodged In space provided. P49NATUR DATE ktEO BY 4 COPIES ORIGINAL -FILE YELLOW- INSPECTOR R � 7 /OyI PINK-OW:=R GOLD�-ASSESSOFI e7 z 0 0 rn