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20040154.pdfDATE RECEIVED [PERMIT EXPIRES USE OCOUIT CITY OF EDMONDS ZONE NUMBE5_!�� CONSTRUCTION PERMIT APPLICATION JOB ADDRESS SUITE/APT#, OWNEgAWEINAA4E.OF BU§INESS PLAT NAME/SUBDIVISION NO. LID NO. MA�ILIAN ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP LID FEE $ I LSCP APP(GV&d RW Porrnit Required Roqd CITY ZIP TELEPHONE EXISTING — PROPOSED Street Use Permit inspection RequIred Sidewalk Required REQUIRED DEDICATION— FT Underground �ulrad �u NAME METER SIZE LINE SIZE NO. OF FIXTURES PIRV REQUIRED YESM NO 13 ADDRESS REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE CITY ZIP ITELEPHONE 2,164w AAnaluifis. NAME I . 11J ADDRESSS CITY STATE LICENSE NUMBER PROPERTY TAX ACCOUNT, PA CBL 0 N I.. ENGINEERING REVIEWED BY FIRE REVIEWED BY ZIP TELEPHONE DATE 1 2-11-71W4 ease DATE W VARIANCE OR Cu SHORELINE OR ADB# INSPECTION BOND EXPIRATION DATE CHECKED BY POS D NEW ADDITION COMMERCIAL REMODEL MULnFAMILY REPAIR CYDS DEMOLISH 0 TANK GARAGE [:] RETAININGWALL CARPORT ROCKERY UWE OF USE, BUSINESS OR A N: ENE-1 NUMBER N UMBER OF a DWELL NO S, UNITS DESCRIBE WORK TO BE DONE C—Ace-r-, 3 __' 7 :1 ChES WO 11$ BEIRA REVIEW SIGN AREA - HEIGHT 'ALLOWED COMPLETE EXEMPT ALLOWED PROPOSED PROPOSED , 0 , EXP 0 LOT COVERAGE REQUIRED SETBACKS (Fr.) 'PROPOSED SETBACKS (FT) PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR COMPLIANCE OR INA z CHANGE OF USE F A. 0 siGN PARKING REO'D PROVIDED L OT AREA PLANNING REVIEWED-& DATE IVA I I 17/?tj�Vt FENCE ( x FT) REMARKS OTHER F SPRINKLER FIRE RE ALARM /�. I N CHECKED BY ITYPTEO U COP,,, U E; G U PAN T CRITICAL GROU AREAS SPECIAL INSPECTION AREA OCCUPANT NUMBERf#_//& REQUIRED [] S LOAD YES REMARKS 1PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REG-D. $ Description fEE Description FEE Plan Check State Surcharge HEAT SOURCE % LOT SLOPE % r 6� Building Permit City Surcharge Base Fee PILAN CHECK NO: 01� �1, VESTED DATE liz— L Plumbing - Mechanical THIS PERMIT AUTHORIMS iIINLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 2 Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE t: SEPARATE PERMISSION. a Engr. Review PERMIT APPLICATION: IBODAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE 13ACK 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 a 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 9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' x — Recording Fee Receipt # 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPPWOVAL GIVEN IS CORRECT; AND THAT ALI THE OWNER, OR THE DULY AUTHORIZED AGENT OF 1 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL This application Is not a P8VMI1 until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED' Building Official or his/her Deputy: and Fees are Paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided. WORKMEN'B,PqiFt�SATION INSURANCE AND RCW)8.27. OFFICIALS SIGNATURE DATE S fl � R A DATE SIGNED (425) So W�� Zjovo ZNA" : , ItWL 771-0220 —7 RE�?41ED BY ATTENTION 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-INSP TOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES (07) lop 10 c MA; rn; 'A 2',DATE RECEIVED CITY OF E9MONDS___ CONSTRUCTION PERMIT APPLICATION ERIME!NAME OF BUSINESS MAILING ADDRESS CITY ZIP TELEPHONE !�=_ I C�w NAME ADDRESS CITY NAME ADDRESS CITY STATE LICENSE NUMBER ZIP ITELEPHONE ZIP I TELEPHONE 0 NEW A-MSIDENTIAL 0 ADDITION 0 COMMERCIAL 0 REMODEL 0 MULTIFAMILY 0 REPAIR CYDS DEMOLISH TANK oGARAGE CAR RT RETAININGWALL -ROCKERY UWE OF USE. BUSINESS OR ACT1VTM_fXJPLA1N: NUMBER NUMBER OF' OF DWELLING STORIES / � /J"I UNITS DESCRIBE WORK TO BE DONE HEAT SOURCE GLAZING % PLAN CHECK NO: CBL # I PERMIT EXPIRES USE ERMIT ZONE 70- R PT PjgVAPT ADDRESS ey PLAT NAME/SUBDIVISION NO. LID NO. LID FEE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP=6d BW ps Street Use Peffnit Req�d EXISTING - PROPOSED Inspection Requited SM&watk Rewired REQUIRED DEDICATION- FT Undergmund Ming req_uM 13 METER SIZE LINE ;i�7 I OF FIXTURES PRV REQUIRED YES C3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/ORAiNAGE _. - 1. " ENGINEERING REVIEWED BY DATE � i /0 !", && i,4= 024111 FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE ORADE111 INSPECTION BOND nON DATE CHECKED BY I REO'D I POSTED I OYES Q14M $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED V/ , 1 0 0A , EXP MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) PLUMBING / ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR 13 COMPLIANCE OR IVA IVA CHANGE OF USE I PARKING LOT AREA PLANNING REVIEWED BY DATE IL SIGN REO`D PROVIDED IVA I ZV 1-7129?+ FENCE FT) REMARKS OTHER F RE SPRINKLER FIRE ALARM CHECKED BY OF CONSTRUCTION CODE OCCUPANT ITYPE I GROUP CRITICAL J AREAS /26 PECIAL INSPECTION AREA OCCUPANT N I REQUIRED [] YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D VALUATION $ Description FEE Description FEE Plan Check State Surcharge LOT SLOPE % Building Permit City Surcharge Base Fee VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONtX ANY CONSTRUCTION ON THE PUBLIC Grading DOIIIUUN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WiLL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPLICATION: 180 DAYS PERMIT UMfP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION iN 'APPUCAK ON BEHALF OF HIS OR HERS1pOUSEHFJRS,ASSIGt4S AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFY. DEFIENQ ANDIHOLb HAK$ALESS THE'CITY OF-'&, Fire Reviow Plan Chk. Deposit EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND hre'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 Landscapelnsp. Total Amt. DUO NOR LIMIT IN ANY WAY THE CfTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT, AND 711AT 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 hiolher Deputy: and Fees are paid, and IN VIOLATION OF THE LABON CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'Sfig"SATION INSURANCE AND RCW�27. 1425) OFFICIALS SIGNATURE DATE _ n �JV 12" q'n <� SIGNPqfl RfiR DATE SIGNED t EMEN 771-0220 D&TE REL AqED BY ATTENTION M 1333 RE UNTIL IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTU A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- INSPEI'(TOR ORIGINAL - FILE YELI OW CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER (301 n - ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES .... . ....... z C: ME 0 0 C M IT11 10 0 _1111 M M Fn C k 8i M C-). z 0 0 ITI