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20040146.pdfM DATE RECEIVED CITY OF EDMONDS CONSTRUCTION P�RMIT APPLICATION OWNFR NAMEINAME OF BU J 7S z*j MAILING ADDRESS ZIP NAM��( ADDRESS CITY ZIP NAME Lie, Pol VV% ADDRESS /—i??—( Lk, CITY STATE LICENI§E NUMBEA PROPERTY TAX ACCOUNT PARCMNO.. �6173.- j0BL # e c� 36 � - 56 NEW W:� RE;IDENTIAL - LUMBING / MECH ADDITION W, OMMERCIAL COMPLIANCE OR 13 CHANGE OF USE REMODEL MULTIFAMILY n SIGN REPAIR GRADING 13 CYDS FENCE _x FT) 0 DEMOLISH [3 TANK OTHER [3 GARAGE CARPORT [3 RETAININGWALL ROCKERY. 0 FIRE SPRINKLER FIRE ALARM (TYPE USE. B SINES,S oR,.AcTMrrfExPLAIN: NUOBER NUMBER OF CRITICAL OF DWELLING AREAS Pr STORIES UNITS NUMBER DESCRIBE WORK TO BE 71NE A11% La,0 PERMIT EXPIRES �_b� —1 � I USE PERMIT ZONE NUMBER JOB ........ .................... . ... . . . . .. . 1.7 fi ADDRESS 217Z&2 4xoqq PLAT NAMEISUBDIVISION NO. LOT 7=0� LID NO. LID FEE S Itti to L;1- PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pat 71tPROVqVild! street Use Peffnit Roq'd EXISTING — PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION— FT Undo ground wirin,g required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES13 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE -P-6-ft- AFFIDAVITS SHAI L -N-0- -1 :NGINEERING REVIEWED BY "BE ACCEPTED DATE FIRE REVIEWED BY DATE Ir. VARIANCE OR CU SHORELINE ORAD.801 INSPECTION BOND REQ'D POSTED OYE'S 13NOIs SEPA REVI EW SIGN AREA, HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED -.Xp , , LOT COVERAGE REQUIRED SETBACKS (FTY"' .P kOPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FR9, LIR SIDE REAR PARKING LOT AREA I PLANNING REVIEWEMSY DATE PROVIDED REMARKS Z"HrCKED BY OCCUPANT ITYPE =CTION GROUP SPECIAL INSPECTIUN OCCUPANT REQUIRED [] YE LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D =s& VALUATION $ 0 DescriptIon Plan Check CE GLAZING % SLOPE % LOT" Bu Permit ilding Plumbing' PL*(CFUECK NO: VESTED DATE Mechanical THIS PERMIT AUTHORIZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO h BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Engr. Review I: 3 SEPARATE PERMISSION. — a PERMIT APPLICATION: ISO DAYS PERMIT L1MrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review '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 FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection 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. a NOR LIMIT 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 CONSTRUC- CALL 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 FORINSPEC T7 W ORKMENS COMPENSATION INSURANCE AND RCW 18.27. (42my 4 SIGNATURE (OWNER 0 AGENT) DATE SIGNED -,1,0 -OLIJ 771-0220 Description State Surcharge City Surcharge Base Fee FEE Plan Chk. Deposit Receipt # Total Amt. Due Receipt # APPLICATION APPROVAL This application Is not a permit until signed by the Building Official or histher Deputy: and Fees are paid, and receipt Is acknowledged In apace provided. BY ATTENTION 1:A I I IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI- 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 M DA DAI*E RECEIVED ju I PERMIT EXPIRES dITY OF EDMONDS USE ZONE PERMIT - NUMBER 12f UoLi CONSTRUCTION P�RMIT APPLICATION JOBI AD RESS SUITE/APrT# ZNAME/NAME OF BUICI PLAT NAME/SUBDIVISION NO. LID NO, 4,0 wo 15 MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP LID FEE 6 I E37CP APP(OVO RW Ps"M Requked PemA 1140 C ZIP ITELEPPONE EXISTING - PROPOSED street Use ed UrAwgrourod REQUIRED DEDICATION- FT WW9 requited METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO 13 ADDRESS' REMARKS Inual 0 NTRA OWNER/CONTRAQSE 6 GE am y Ul 1111011 CITY ZIP, TELEPHONE OB Alk-11-Al I HAT NAME CBL# ENGINEERING REVIEWED BY DATE 19 ADDRESS 0 121 CITY 0� . Pr j(p A -qELEPHONE ) %" � - 516 1/ STATE LIC E NUMBER ACCOUNT PARCEL NO. 0 NEW rl RESIDENTIAL 0 ADDITION %;*-COMMERCIAL REMODEL MUL11FAMILY REPAIR GRADING Cyos 0,.DEMOLISH TANK GATME RETAININGWALL CARPORT ROCKERY SINESS-OR ACWrrf"LMN; NURiER OF - STORIES NUMBER OF �DWELLING UNITS DESCRIBE WORK TO BE E FIRE REVIEWED BY DATE 1 Im VARIANCE OR CU SHORELINEORADB11 I INSPECTION I BOND REQ'D POSTED 13YEs 11jo s SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED I PRO P 0 BE D LOT COVERAGE REQUIRED SETBACKS (Fr.). PROPOSED SETBACKS (Fr.) LU ArPMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR COMPLIANCE OR 1:1 13 1% 1 CHANGE OF USE Aft A& 0 PARKING Ic DATE SIGN IEUffL0jMnN1r RECID PROV D L) 13 FENCE X FT) REMARKS E] OTHER FIRE SPRINKLER 0 FIREALARM 6HE6KED B� TYPE CTrN bdcdu GROUP. CRITICAL AREAS Or SPECIAL INSPECTION JAREA _frCTION OCCUPA14T NUMBER REQUIRED LOAD Li REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D I I I . 11 . : . � .1 1 VAWATION Description Plan Check HEATSOUIRCE GLAZING % LOT SLOPE % Building Permit PIJUCFM,CK NO: VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURSS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL R 9WIRE SEPARATE PERMISSION. Engr. Review 15 PERMIT APPILICATION: 160 DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 1APPLICAN i, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review IN INTEREST, A13REEII TO INDEMNIFY, DEFEND AND HOLI) HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection ALL CLAIMS FOR DAMAGI!S OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCIf OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- I — __N�Wnmm — � Recording Fee I HFREI3Y 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- CALL 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 FOR INSPECTIII WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. __I� DATE SIGNED SIGNATURE (OWNER O�_AGENTI ) 1A d! 05) �A�vc;, - LI: i �_ � -OLIJ 771-0220 k�_ FEE Description FEE State Surcharge City Surcharge 77- Base Fen 0 U Plan Chk. Deposit Receipt # Total Amt. Due Receipt # APPLICATION APPROVAL This application Is not a permit until signed by the Building OMcW or his/her Deputy: and Fees are paid, and receipt Is acknowiedged In space provided. A LS SIGNAT E PATE -LEASED BY DATE( ATTENTION M 133 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING ORSTRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFI 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