20000510 (2).pdfDATE RECEIVED
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PERMIT EXPIRES
CITY OF EDMONDS Nu BER
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS /- Z
J,SUITEIAPT#
OWNER NAMEINAME OF BUSINESS/ �i
fVF ~ C�g Q PLAT NAME/SUBDIVISION NO. LOT NO LID NO
W MA .INGAD RESS " LID FEE
— PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE0 RW CwAp Rege(ired O
CITY ZIP TELEPHONE EXISTING PROPOSED seem use Permit Required 0
�D � � y, ��r^ 7 Inspection Required Roqud
Sidewalk Required 0
9&7` REQUIRED DEDICATION FT uninq t6u a O
Wrtm m u:red 0
NAME METER SIZE LINE SIZENO. OF FIXTURES PRV REQUIRED
u YES O NO 13 _
Lu
I= ADDRESS REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
Q w
CITY ZIP TELEPHONE
NAME ' 717/1
rFr co c `9DATE
Ix ADD ss RE
MARSHAL
/ , FIREREV�EANK TILL, REMOVAL Lift lJ!'11� DATE
CITY ZIP TELEPHONE r LL
ON�
o S e If & 0 o Vip17 � .
STATE LICENSE NUMBER EXPI TION DATE y VARIANCE OR CU SHORELINE OR ADB#. INSPECTION SEPA
l U1 C,IY Fe �G/ / a / Q F! � REQ'D COMPLETED EXEMPT
YES � NO
ROPERTY T COUNT PAJ2C L NO. CA# ZONE SIGN AREA' HEIGHT
W je7 J/ �y •'�i jj 0� WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
741
7 (/ / L/ STUDY O
❑ NEW RESIDENTIAL ❑ PLUMBING 1 MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑
ADDITION COMMERCIAL COMPLIANCE OR
❑ ❑ z
❑ MIXED USE CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED a
❑❑GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
❑ DEMOLISH TANK ❑ OTHER
❑ CARPORT IERY FIRE L RAGE RETAINING WALL ❑. FIREAKLER
z ROCKRM
(TYPE QF USE, BUSINESS R ACTIVITY EXPLAIN:
uI TA v J {Moe A50V /r. TYPE OF NUC C��j GROUP OCCUPANT
cNUMBER ,v ` NUMBER OF j (!_ IJ 7LI/,v► /✓�
OF DWELLING I SPECIAL INSPECTION CONSULTANT OCCUPANT
o STORIES 1i�C UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED 13YES
REMARKS cs
z.
00 67 I GEOTECH REPORT m
\ STRUCTURAL DESIGN
BY:
V 6lG % VALUATION
GGI.� ON fiellovc l/Pilit dr`%Ph $
~ >S C Q X%!c ! Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE )
Building Permit l City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
ccEngr. Review
cc PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
tin *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS 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
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording FeeReceipt #
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 Fees are paid, and
IN VIOLATION OF THE LABO CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENS17RINSIVANCE AND RCW 18:27,
OFFICIALS IGNATURE DATE
SIGN (O ER E DATE IGNED (425)
,/00/ 1 771 -0220RELEASED BY ATE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109If IBC1101 IRC110. ORIGINAL -FILE YELLOW
.PINK -OWNER •GOLD •ASSSSSSESSOROR
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
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