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20040066.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION fR NAME/NAME OF BUSINESS j i MAILING ADDRESS orl I C) CITY ZIP 'ELEPHONE -7 7 NAME ADDRESS CITY ZIP ITELEPHONE NAME ATDRf,SS zlod�—ffi" C TELEPHONE qozp 7�z STATE LICENSE NUMBER . ExaPF4TION DATE &WH / e�� .9 7 Oe, VZ)oj- PROPERTY TAX ACCOUNT PARCEL NO. 0-7 6W 4?/V-) 1^-'q TO 0 NEW RESIDENTIAL K!, I . ADDITION COMMERCIAL REMODEL MULTIFAMILY REPAIR GRADING CYDS DEMOLISH 0 TANK oGARAGE CARPORT o RETAINING WALL ROCKERY OWE OF USE, BUSINESS OR ACTFV" EXPLAIN: _7F A NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE r11 N , _L/j I I PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB ADDRESS -7-716 2-Jd >fq J�a�5w SUITE/APT# __� PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APP(Gv&d RW Pe"n" Re :, U.. p.. 'd 13 1 EXISTING - PROPOSED Inspectio Rmuked SidewalknRaquir6d 0 REQUIRED DEDICATION- FT underg Widno roQuired CI METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YESO NO CI REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE DBsFgvFp BY CITY INSPECTOR # NOT . AFFIDAVITS SHALL ENGINEERING REVIEWED BY � DATE BE ACCEPTED FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINEORADSO I INSPECTION BOND CHECKED B)f :REO'D POSTED 1$ 13YEs I 3NO SEPA REVIEW SIGN AREA '' . HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED., ALLOWED ROPOSED EXP I ^M REQUIDED 0—ya R �' '—pneen SETBACKS IFT.1 [,M PLUMBING I MECH % 0 2 ALLOWED PROPOSED FRONT SIDE REAR FROtF., LIRSIDE REAR COMPLIANCE OR 0 CHANGE OF USE 0 SIGN REQ` PARKING LOT AREA I PLANNING REVIEWED'1W DATE 0 FENCE ( — X—FT) REMARKS 0 OTHER F RE SPRINKLER FIRE ALARM 11 CRITICAL CHECKED BY ITYPE 00 ON AREAS SPECIAL INSPECTION [AREA NUMBER REQUIRED [] YES REMARKS 1PROGRESS INSPECTIONS PER UBC OCCUPANT GROUP OCCUPANT LOAD INSPECTION REG'D 1 5 _34 4&d1"%A-_V - I I I A ]IVA rnw e. VALUXTION d5 $ V Description FEE Description FEE '4 Plah Check State Surcharge HEAT SOUTE GLAZING % LOT,SLOPE % Building Permit City Surcharge PLAN C:HECK NO: VESTED DATE Plumbing' Base Fee Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERITY ONLY. ANY CONSTRUCTION ON THE PUBILIC Grading 3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPILICATION: ISO DAYS PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICAN-L 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 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 Landscape Insp. Total Amt. Due 0 NOR LIMIT IN ANY WAY THE crrrS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." 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 permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Foes are Paid. and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space pr"ded. WORKMEN'S COMPENSA)Q��NCE AND RCW 18.27. SIGNAT�j (OWNERO I AGE D GNED (A9 1,425) i,,__ 11 LS;SIGNMATE Tn 771-0220 4DATE 4111 1,7 EASED a AE A&EATION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE YELLOW- INSPECTOIJ PINK -OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES PERMIT EXPIRES USE PERMIT CITY OF EDMONDS ZONE NUMBER C�00�- (,U(OV CONSTIRUCTION PERMIT APPLICATION JOB SUITE/APT# R NAME/NAME OF BUSINESS ADDRESs7-7/4) Zjoj LID NO. I PLAT NAMEISUBDIVISION NO. LOT NO. MAILING ADDRESS () q I D Q16f-)7 CITY ZIP ITELEPHONE F_ o+ iv-L v,4d-r *6,v. V2,�- 17q NAME ADDRESS CITY ZIP ITELEPHONE NAME CBL# 1'014'�Ik CA9.1r-9 L, L��l 1 /&/0 A, DqD R ES S 2�00 del k-� C I P TELEPHONE STATE LICENSE NUMBER EXPI,R# ION DATE ,T CHECKED e'- V &)A-JH 1 49 7 / 0/? , 71?.L_ PROPERTY TAX ACCOUNT PARCEL NO. -o--7 4�4 6711,-") 70 0 [:] NEW K! ESIDENTIAL [3 ADDITION COMMERCIAL 1:1 REMODEL MULTIFAMILY 0 REPAIR GRADING CYDS DEMOLISH TANK GARAGE CARPORT RETAININGWALL ROCKERY ME OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMBER OF OF DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESC P:"A.,=, RW r, Street Uss Permh Roo EXISTING — PROPOSED— Inspectlon Required Side*&* Required REQUIRED DEDICATION— FT UndergroiM WWmg required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES 13 NO 13 REMARKS OWN ER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE ORADB11 I INSPECTION i BOND REOD POSTED 13YES 13NO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE _ EXEMPT ALLOWED . PROPOSED ALLOWED . PROPOSED W rL LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) PLUMBING / MECH O(COMPLIANCE ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR I OR CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE SIGN RECID I PRCVIDED I I o FENCE I ( — X FT) REMARKS OTHER Aft F RE SPRINKLER FIRE ALARM -q nc"('_7 I CRITICAL AREAS NUMBER HEAT GLAZNG % LOT SLOPE % ,qsqour PLAN tHECK NO: VESTED DATE THIS PERMIIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMff APPLICATION: 160 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 INDEMNIFX 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 PERMM 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 ABILrrY` TO ENFORCE ANY ORDINANCE PROVISION." I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECr AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND.9TATE LAWS REGULATING CONSTRUC. TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR,060DE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATP .4"NCE AND RCW 18.27. SIGNATU (OWNER 0 )rE" DAT� 'NED CHECKED BY ITYPE OVONS MRTION 0 UFANI d1j 17k)- GROUP E. SPECIAL INSPECTION JAREA OCCUPANT - REQUIRED [:] YES LOAD REMARKS PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION RECII'D 9 '�:� A '-N a 1- 4 J f) (\A If f�. 1� _�N Al). '11 4';1.0 2 $ [- - - V I Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge 14'5— Plumbing Base Fee '01 Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION 11110 %425) 771-0220 EXT 1333 APPLICATION APPROVAL This application Is not a permit until signed by the Building Offlclal or his/her Deputy: and Fees are paid, and receipt Is acknowiedgod in space prc�lded. SIGN7AT /bDATE JAL YREASED BY di � IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINALINSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- INSPECTOR CATE 00"OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES z 0 =1 0 M