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20040479 (2).pdf_IIAIE RECE C1W OF EDMONDS CONSTRUCTION PERMITAPPYC ION I/ /PC OWNER NAME/NAME OF BUSINESS-- —r,3LI V (/�" 1(1� 4- Ll M 54 _T 6 Oz to M r, #'d, MAILING ADDRESS 7 CITY ZIP ITELEPHONE o—s qE,2,6 I //,, �__ NAME 7RCSS L) cc <1 CITY NAME ZIP TELEPHONE C CBL4\ ; cc ADDRESS 0 cc r CITY ZIP TELEPHONE %14 ILI 0 u lt::iR ol� C� L 1� STATE LICENSE NUMBER EXPIRATION DATE Y 0 WNU— O(E4 6 tj T PROPER jjj�_JAX COUNT PARCEL NO. rz 5 (e -- 4 00 -- L/ o/ NEW RESIDENTIAL PLUMBING MECH ADDITION COMMERCIAL COMPLIANCE OR El CHANGE OF USE REMODEL MULTIFAMILY 0 REPAIR GRADING FENCE CYDS ( X Fr) DEMOLISH TANK OTHER GARAGE CARPORT RETAINING WALL FIRE SPRINKLER ROCKERY FIRE ALARM 0 r (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: L A , I_fl M a NUMBER NUMBER OF CRITICALVLAJfiNVL-F— in o OF STORIES DWELLIN G UNITS AREAS/'1-1 NUM —a� W2, c ) � ( (:7 t\,w Qc. 1r4,_,fl"k6j_h �_ 4 C ' '(; HEAT SOUJCE GLAZING LOT SLOPE % in 1� PLAN CHECK NO: VESTED THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PEnMIT`COVERS WORK TO I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. cc W PERMIT APPLICATION: 100 DAYS PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OH HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND 1101-D HARMLESS THE CITY OF _j 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND x < ALL CLAIMS FOR DAMAGES OFINHATEVER NATURE, ARISING DIRFCTLYOR INDIRFCILY x FROM 1HE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERMIT SHALT. NOT BE 0 _j DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY Cl IY ORDINANCE 01 NOR LIMI f IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUrtioRIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC 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 WORKMEN'S COMP5NS 'IDP CE ANDflCW 18 27. SIG UR 77DATE�SJ6,N[D, y USE ZONE JOB ADDRESS2 053 (�f) ) PLAT NAME/SUBDIVISION NO PERMIT EXPIRES PERMIT NUMBER I'IA�l LIJ LOT PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING PROPOSED REQUIRED DEPICATION� FT METER SIZE I LINE SIZE I NO. OF FIXTURES SUITE/APT# LID NO. LID FEE $ nESCP Approved JJW PLrnet Raquead Street Use permit Fieri'd inspection Raqua0d Sidewalk fitiquirad underground Wiring required PRV REQUIRED YES 11 NO 1:1 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING REVIEWED BY FIRE REVIEWED BY Fn 10 1k U4 DATE 0 W z z 5 z W T11 VARIANCE OR CU ORELINE OR ADBI I INSPECTION BOND REQO POSTED 1z 1�&7--gr7 OYES ONO I S SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED ED I P<� ja # 3 __, 17 EXP _ [431� 01 _S :��E/ LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR z E z PARKING LOT AREA I PMREVIEWEQ BY DATE REO'D I PROVIDED S �, t ��, �'/l 716 1;1;LV01m%11 CHECKED PE C NSTIJUCTION GQDE OCCUPANT GROUP SPECIAL IN PJTy1oN REQUIRED AREA 2 3(� OCCUPANT LOAD 2__ [] YES REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D VALUATION Description FEE Description FEE Plan Check C State Surcharge Building Permit City Surcharge Plumbing Base Fee Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp- Total Anit. Due Recording.,� Receipt tt APPLICATION APPkOVAL I his application is not a permit until signed by The CALL Building 011icial or his1her Deputy: and Fees are paid, and -OR INSPECTION receipt is acknowledged in space provided FICIALS SIGNATLJ kIE DATE F Ac ATTENTION E)ff 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 0903 PRESS HARD -YOU ARE MAKING 4 COPIES 11'12 ORIGINAL � FILE YELLOW - ASPE(JrOR PINK - O�'VNEM - GOLD - ASSESSOR I z 0 1 0 1711 --I -n Fn --I X 0 M C 1711 0 0 —4 (-) 0 C M M Z jo —i C: -Z x 0 -n n X .1 > t 9 M M 0 -C/) or- 0 M C (1) 9 C/) M C-) Z X z Cn z 0 1 0 M I FINAL PROJECT APPROVAL FORM TO: DATE: MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: YIRE DEPARTMENT DATE PLEASE SIGN ENGINEERING DIVISION DATE - PLEASE SIGN _�&VL PLANNING DIVISION DATE 7171Q'I PLEASE SIGN PROJECT SITE ADDRESS L-2L) & I I I t/v -7 1 1 -77 PERMIT ADB# -DATE INSPECTED DESCRIPTION OF WORK TO BE INSPECTED A field inspection was conducted to determine compliance with -approved plans. Final approval denotes that there are no objections from the above signed Department to the release of PERFORMANCE BONDS and the granting of: 1// GRANT FINAL PROJECT APPROVAL GRANT PROJECT APPROVAL WITH CONDITIONS NOTED El Copy of CONDITIONS given to owner/contractor by inspector FAILED FINAL INSPECTION - OUTSTANDING ISSUES Copy of CORRECTION NOTICE given to owner/contractor by inpector 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Signature 1:temp:b1dg:fbnns:ocaprv1 3/25/04 z 0 i 0 M —i -n M M 0 0 0 X M M Z 01 C C0 0 -n n M > M M 0 0 M Cn M 0 Z r- r z z 0 M ATTENTION I I jjj 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 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES N, -IVr DATE RECE. USE CITY OF EDMONDS ZONE CONSTRUCTION PERMIT APPLICAT17ON JOB 1 1 .� " ./ ADDRESS OWNER NAME/NAME OF BUSINESS P IVISION NO. PLAT NAME/SUDD r MAILING ADDRESS—— FERMIT EXPIRES P 7T PERMIT V 7cl NUMBER.' Z) LOT NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP CITY TELEPHONE EXISTING PROPOSED ZIP REQUIRE T D DEDICATION- FT NAME METER SIZE LINE SIZE NO. OF FIXTURES I kADDRESS CITY ZIP ITELEPHONE NAME Llt"J.;( CIL I ADDRESS 1-J CITY Z, TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY J PROPERTY TAX ACCOUNT PARCEL NO. (r NEW RESIDENTIAL PLUMBING MECH COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE REMODEL MULTIFAMILY SIGN FENCE REPAIR GRADING CYDS t X FT) OTHER DEMOLISH TANK f_1 GARAGE o RETAINING WALL o FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMBER OF CRITICALL - "'Ir DWELLING AREAS,* , OF , f),_ 2 STORIES UNITS NUMBER/ . . . K2, DESCRIBE WORK TO BE DONE t Z-9 A t.� (1,/n 14 W( "c' jr ( I I') I I J� , .6", , 6, 1 ) bc, i fli 1"'Ifft- HEAT SOURCE I GLAZING %it LOT SLOPE % PLAN CHECK NO: VESTED DATE" 41 .7,0 1, THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT'COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT LIMIT. 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 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 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0 SUITE/APT# LID NO. LID FEE $ ESCP Ap roved [3 Aw Permit Required E3 street Use Permit Roq'd (3 inspection Required 13 Sidewalk Required E3 Underground wiring required E3 PRV REQUIRED YES 13 NO 0 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE FIRE REVIEWED BY DATE DATE 0 z cc W z VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REO'D OYES ONO POSTED I S SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED. , -7 EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR z z 5 PARKING REQ'D DED PROW LOT AREA IPL� NNING REVIEWED BY DATE 71 916 j P/1 -1 REMARKS CHECKED BY TYPE OF.qONSTRUCTION qODE. OCCUPANT GROUP SPECIAL INSPECTIONF- AREA OCCUPANT REQUIRED LOAD I/ I.., REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5 VALUATION Description FEE Description FEE Plan Check e,2 State Surcharge Building Permit City Surcharge Plumbing Base Fee Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due 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 /IGENT OF This application is not a permit until signed by the THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building olficial or his/her Deputy: and Fees are paid. and 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 acknowledged in space provided. WORKMEN'S COMPENSATION INSUF!A!4CE AND RCW 18.27. DATE OFFICIALS SIGNATU RE SIGNATURE (OWNER OR AGENn DATE SIGNED (425) 0 f 771-022 ED BY DATE ORIGINAL - FILE YELLOW - INSPECTOR PINK - OWNER GOLD - ASSESSOR D al z 0 M -i -n 0) 0 M C 0 M 0 10 0 (Z .-1 9 X M M z JD --I _z X W o -n n X > M M 0 0 0 M C U) K (n M Z z CD z 0 1 0 M