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20040322.pdf7 '77 .:07DATE RECEIVE PERMIT EXPIRES —7--7 CITY OF EDMONDS USE PERMIT ZONE NUMBELJ,,� CONSTRUCTION PERMIT APPLICATION JOB U ADDRESS Ll O= 017JUISOMS 4�j PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. MAILI SS -7:7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP LID FEE $ TESCP Approved RW Pernill Required Z I P/,J, T LEPHONE EXISTING — PROPOSED Street Use Ponnit RKd Inspection Required Sidewalk Required Underground QUIRED DEDICATION— FT A Wiring requirW 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED YES [3 NO 13 ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE CITY ZIP ONE NAME CBL#% Fe - 2�- Nb , do'2: 1 '*5" . (Y(\ ENGINEERING REVIEWED BY DATE 7W W � M&L I i FIRE REVIEWED BY DATE TELEPHONE ZIP V. cc IE6 STATE LICENSE N UMBER EXPIRATION DATE CHEC D BY VARIANCE OR CU I SHORELINE OR ADBO I INSPECTION REO'D BOND POSTED I OyEs ONO $ SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLET EMPT ALLOWED PROPOSED ALLOWE13 PROPOSED /01 dj240 10/ , , EXP NEW I J;XRESIDENTIAL PLUMBING / MECH fi<POMPLIANCE LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (Fr.) FRONT SIDE REAR PROPOSED SETBACKS (Fr.) FRONT LIRSIDE REAR I ADDITION COMMERCIAL OR 9 CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE I m v L-1 . V..6 rAUL11rtW1%.T SIGN REQD I PROVID I- R r P A 0 REPAIR IR GRADING OYDS FENCE X FT) REMARKS E '0 U 0 DEMOLISH S I [j TANK OTHER Aw oGARAGE A R G C A CARPORT RPOFn F USE, OWE OF USE, BUSI "6 0 RETAININGWALL ROCKERY OR ACTIVITY'i EXPL94N: FIRE SPRINKLER FIREALARM CHECKED BY ITY=N 77c OCCUPANT GROUP I NUMBE NUMBER OF 0 0 0 F WELLING 0 STORI;;6��UNITS D S Is WM ESCRIBE WORK TO BE DONE T—CRITICAL AREAS NUMBE SPECIAL INSPECTION JAREA REQUIRED 0 YES OCCUPANT LOAD REMARKS ix2vt�Az:_' 17e- PROGRESS INSPECTIPA _ I LE&UPQ uno Firc-FEW"11.1,31 IMfIbLAL&SPECTIPON RECtO ot VALUATION $ Description 1LPnVtU9__QF[n woo 16V FEE Description FEE Plan Check State Surcharge HEAT SOURCE NG % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing A Base Fee Mechanical THIS PERMIT AMOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO lz BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC a Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS PERMIT ILIMM 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 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Insoecitlori Receipt N ALL CLAIMS FOR DAMAGES OF WHATEVER NATUREj ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE, DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMCENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt III 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 13 not a penrill 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'P,W,FNSATION INSURANCE AND RCW 18 27. 1 01717it.S SIGtjATURE DATE SIG 0 E DATE I ED 11425) 771-0220 _�iELEAS&BY'_ '77 WZe ATTENTION 7-77- EXr 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 - YELLON- INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING4 COPIES INEEMIS k 0 F9 M M_ OC M HID Z M rn Cr z 0 M 11 VED DATE RECEI 74L PERMIT EXPIRES USE PERMIT CITY OF EDMONDS ZONE NUMBER JOB SUITE/APT# CONSTRUCTION PERMIT APPLICATION ADDRESS .7 () z 5— / z OWNER NAMEINAME OF BUSINESS ME LID NO. P NAME/SUBDIVISION NO. LOT NO. Cr6e MAILING ADDRESS 70z';' ig Z A,.( L CITY ZIP TELEPHONE 6- d." e'. W '990z'61 (V z ir— 6 70 —8 NAME ADDRESS CITY ZIP NAME a.. - it P"4 1 we We CITY ZIP f— it Ag.1 Aejd4A*f 918 STAfE LICENSE NUMBER TAX ACCOUNT PARCEL NO. CBL # TELEPHONE EXPIRATION DATE I / 0 f)5 LID FEE S _1ESCP A0proved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pstrnn RaW:9d Sjrgol Use Penn Roq'd inspection FWqt*od EXISTING — PROPOSED Sidewalk R*Quif*d REQUIRED DEDICATION— FT Underwound ad 13 METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRE I YES 13 NO 1FREMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE By FIRE REVIEWED BY D T DATE W cc ir IANCE OR CLI SHORELINE OR ADB# INSPECTION BOND B REOI'D POSTED 113YEs 13NO IS SEPA REVIEW SIGN AREA Dj_ HEIGHT COMPLETE . EXEMPT ALLOWED , PROP BE ALLOWED I PROPOSED LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.) URSIDE REAR 1:1 NEW RESIDENTIAL 19 PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT I 13 ADDITION COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE 0 REMODEL MULTIFAMILY 0 SIGN REOD I PROVIDED 1:1 REPAIR 0 GRADING CYDS FENCE X FT) REMARKS DEMOLISH [3 TANK OTHER GARAGE CARPORT [3 RETAINING WALL ROCKERY FIRE SPRINKLER FIRE ALARM (TYPE OF USE. BUSINES§4* ACTIVITY1 EXPLAIN: CHECKED BY ITypE 0 OCCU PA STRUCTION GROUP ;Nk NUMBER NUMBER OF 61RITICAL AREAS, SPECIAL IN SPECTION 'ARCA OCCUPANT LOAD OF STORIES DWELLING UNITS_ INIUMBF REQUIRE DESCRIBE WORK 110 BE DONE tz,e lot e, i3a re h .,a 4d REMARKS -------- INSPECTIONS PER UBC 1106/FINAL INSPECTION 11111tizu if AV 4 xL1.5 Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE V— GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing . 6A� Mechanical THIS PERMIT AUTHoRMES 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 SEPARATE PERMISSION. Engr. Review PERMITAPPLICATION: 180DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WTrHIN 180 DAYS Engr. Inspection ........ SEE BACK OF PINK PERUIT 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 OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # EDMONDS. WASHINGTON, ITS ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMrr ISSUANCE OF THIS PERMIT SHALL NOT BE WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due DEEMED TO MODIFY, NOR LIMIT IN ANY WAY THE CITYS 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 TO COMPLY W FrH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the Building Otklal or his/her Deputy: and Fees are paid, and THE OWNER. I AGREE 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 INSPECTION receipt Is acknovAedged In apace provided. "a " '1' — WORKMENS COMPENSATION INSURANCE AND RCW 18.27. sl URE DATE SIGNATUP-MW�gR DATE SIGNED 1A 5) 142 —7 ap-7/ *DA ftRELEASE 771-0220 BY' DA ATTKTION 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- ORIGINAL -FILE - YELLOW- INSPECTOR GOLD -ASSESSOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 COPIES ARE MAKING 5 PINK -OWNER - GREEN - ACCOUNTING 04/02 PRESS HARD -YOU I