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20040062.pdfI . _1�1 - FDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION DW71�R NAME/NAME bF ss I u 7 tatorm ) MAILING ADDRESS CITY ZIP TELEPHONE �7/ NAME ADDRESS CITY ZIP TELEPHONE N W,, A NArwr Ahm- ADDRESS 4 CITY ZIP,,-\ 1179141ribliNE STATE LICENSE NUMBER 0 NEW RESIDENTIAL 0 ADDITION "I'V-1COMMERCIAL I'aAEMODEL MULTIFAMILY 0 REPAIR GRADING CYDS 0 DEMOLISH TANK 0 GARAGE o RETAININGWALL CARPORT ROCKERY - (TYPE OF USE. BUSINESS OR ACTIVTM EXPLAIN NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE PERMIT EXPIRES us PERMIT ZONE NUMBER JOB ADDRESS j SUITE/APT# PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE $ TESCP Apptovad PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP fOWNER/CONTRACTOR nW Permit Required Stre,llI,9ParrnftRaq'd EXISTING - PROPOSED InspectlOn Requited Sidewalk Requited 13 REQUIRED DEDICATION- FT undergrowd Wiringrequirad METER SIZE LINE SIZ�'7, OF FIXTURES PRV REQUIRED YESE3 NO 13 REMARKS RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CBL N ENGINEERING REVIEWED BY DATE FIRIE. RE-v-IEWED BY DATE uj cc M I VARIANCE OR CU SHORELINE OR ADS# INSPECTION BON Wi6—NDATE CHECKED BY REO'D POSTED I 10YEs ONOIS SEPA REVIEW SIGN AREA: HEIG COMPLETE I EXEMPT ALLOWE13 , PROPOSED, ALLOWED PROPOSED 0 EXP LOT COVERAGE REQUIRED SETBACKS (177)�- PROPOSED SETBACKS (Fr.) IJ-10LUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT. URSIDE REAR R z Nj:�GE ON-LISS11- A PARKING DATE SIGN I LOT AREA PLANNING REVIEWED BY IL FENCE REOID I X Fr) REMARKS OTHER 0 FIRE SPRINKLER FIRE ALARM CHECKED CRITICAL AREAS SPECIAL INSPECTION [REQUIRED NUMBER [3 YES REMARKS OCCUPANT GROUP OCCUPANT LOAD PER UBC WOMINAL INSPECTION RE0101 is . A, '- '�' . - , C-_"l /,--7 ' .1 —,A n I — I $ 1 U U_ oescription FEE Description FEE State Surcharge Plan Check GLAZING % City Surcharge HEAT SOURCE LOT SLOPE % Building Permit PLAN CHECK NO: VESTED DATE Plumbing Base Fee Mechanical I THIS P I ERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: ISO DAYS I PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 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 EDMONDS, WASHINGTON. ITS OFFICtALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 0 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY SHALL NOT HE -7 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Receipt # Recording Fee 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 permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Official or his/hot Deputy: and Fees are paid. and receipt Is acknowledged In space provided. IN VIOLATION PF THE WORKMEN'SYOMPyfiAT"NSURANC No RCW 10.27. I1--- OFFICIALS SIG"TURE DATE SIGNATU (0 R DATE S NE (425) 1 4 AX ;/, IIZ7�z -2 I / 72- - 7 L(�4. 771-0220 VY - r, E—L E—A smo- DATE/ ATTENTI Off 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 - YELLOW. INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES 9 UL I 4 1 V,DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION R NAME/NAME OF BUMESS Q) ,I M I J�', f ) r1i ils - LLO PERMIT EXPIRES Fuse PERMIT ZONE NUMBER MAILING ADDRESS CITY ZIP TELEPHONE NAME st�� ADDRESS IN PLET CITY ZIP TELEPHONE CBL# j CITY P , Z12,0 E STATE LICENSE NUMBER Ev"I"W"N "ATE I CHECKED BY I Zfu T - 1[ -- LJ-11 — L"I'll NEW 1:1 RESIDENTIAL 1:3 ADDITION —12VOMMERCIAL 3pe EMODEL 0 MULTIFAMILY REPAIR GRADING CYDS DEMOLISH TANK oGARAGE CARPORT RETAININGWALL ROCKERY ME OF USE. BUSINESS OR ACTIVITn EXPLAIN' NUMBER —NUMBER OF OF OWEI I ING STORIES DESCRIBE WORK TO BE DONE 2 -L)L�c Al—SLUMBING I MECH AE�!�R EOFUS SIGN F NCE ( E —X— OTHER FIRE SPRINKLER FIRE ALARM Ann ADDRESS SU[TE/APT# PLAT NAMEISUBDIVISION NO. LOT NO. OWN LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved AW P@m* Required Street Use Penrift Req'd EXISTING — PROPOSED Inspecdon Raquitect Sidewalt Required REQUIRED DEDICATION— FT UndergrotmW Widngrequirod 13 METER SIZE LINE SIZE]--Z. OF FIXTURES PRV REQUIRED YEsI3 N 0 13 REMARKS z OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE DATE FIRE REVIEWED BY DATE VARIANCE OR CU I SHORELINE OR REO'D --Is POSTED 113YES 13No SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I I LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR PARKING LOT AREA PLANNING REVIEWED BY DATE PHU FT) REMARKS CHECKED BY I TYPE C CRITICAL AREAS SPECIAL INSPECTION IBER REQUIRED [:] YES R M EMARKS Description Plan Check HEAT SOURCE GLAZING % LOT SLOPE % Building Permit PLAN CHECK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURDS, SIDEWALKS, ORNEWAYS, MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: ISDDAYS a. PERMIT ILIMIR I WAR - PROVIDED WORK 19 STARTED WTTHIN 100 DAYS Engr. Inspection I SEE BACK OF PINK PMWrr FOR MORE INFORMATION OCCUPANT GROUP OCCUPANT LOAD I PER UBC 108/FINAL INSPECTION REG'D f 11,01 A J'- �') <�'�/ , -).e 1'w-A 'n s � FEE d Description FEE State Surcharge City Surcharge_ Base Fee '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 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY I 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 Landscapeinsp. Total Amt. Due NOR LIMIT IN ANY WAY THE cilys ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN 18 CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPRUV—AL---r THE OWNER. I AGREE TO COMPLY WMI CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the TION; AND IN DOINGTHE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Oftlal or his/her Deputy: and Fees are paid, and IN VIOLATION 9F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowtodged In space provided. WORKME!!PM5r "ONSURANC5AND RCW 18.27. OFFICIAL�p SIGI`�ATURE TE SIGNATU 'T ATE ED (425) M(�W 1 77 cu* 171 -0220 71, Is r Mon RELEiSED fiY DATE ,,,ATTENTIC$N EXr 1333 ;,Z IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- po,>-t cad -sei- CIINAL-FILE - YELLOW-INSPECTO CATE M OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 �n!NK-OWNER - GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIZO,