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20050006.pdfi DATE RECEIVED V CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESSj,q.l,�r�� �irfj �"j`I _�L71 t7 MAILING ADDRES��i J14447 1� CITY ZIP TETPHONE PERMIT EXPIRES r> USE PERMIT ZONE (k NUMBER ����� _)�1 JOB��� t / Iy2 �a SUITE/APT# ADDRESS 00� / PLAT NAME/SUBDIVISION NO. LOT NO LID NO. LID FEE f W Pe PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RApproved Q PW Permit Required O Shoat Use Parton Roq'tl EXISTING PROPOSED InspectionRequired Sidewalk Roqulred REQUIRED DEDICATION FT Undarground Wiring required O NAME t METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED /— l7 YES 1:1NO ❑ IM ADDRESS` REMARKS 2 OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIPT EPH E err NAME ��yY ,% j- j L •� , 1 C _ ✓{ ./ �' ! \�''" t.G'1 _�✓t ENGINEERINGREVIEWEDBY, / D TT ADDRESS J/1 N / w i( 1 � . L 2UJ i11 FIRE 9EjfIEWED BY DATE Q CITY ZIP TELEPHONE e�2 - INS WOMEN VARIANCE OR CU (—` SHORELINE OR ADBN INSPECTION BOND STATE LICENSE NUMBER EXPIRAT ON ATE CK B Sj4 POSTED W -�1 1 �� CIYES NO S sq SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 2.`� EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) E]NEW ElRESIDENTIAL ❑ PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR COMPLIANCE OR ❑ ADDITION COMMERCIAL ❑ CHANGE OF USE PARKING LOT AREA P NING REVIEWED BY DATE g ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED ❑ REPAIR ❑ GRADING CYDS ❑ PENCE X FT) REMARKS ❑ DEMOLISH 6 TANK 8niVft0j ❑ OTHER GARAGE RETAINING WALLFIRE SPRINKLER ❑ CARPORT ❑ ROCKERY E:] FIRE ALARM (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPEVOC S U OCCUPANT • if GROUP NUM ER UMBER OF CRITICAL OF / DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT STORIES UNITS NUMBER V/ REQUIRED ❑ YES LOAD DESCRIBE WORK TO BE DONE REMARKS 9 z PROGRESS INSPECnONSPER UBC 106/IBC109ifIRC109FINAL INSPECTION REO'D ,,.Liem VALUATION 1� Description FEE . Description FEE -� — o�, / r P[ O I b Plan Check Stale Surcharge J�(�) HEAT SOURCE GLAZING % LOT SLOPE % Building Permit �. Ci Surcharge: 4� r / VESTED DATE Plumbing Base Fee PLAN CHECK NO: (j J( Mechanical THIS PERMIT AUTHORIZES 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 PERMIT APPLICATION: ISO DAYS PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 160 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 Inspection / Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY L. FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landsca a Ins DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P P Total Amt. Du© NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION' n Recording Fee Recoipt q j I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ry' THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT; AND THAT I AM THE OWNER,.09 TH D LY AUTHORIZED AGENT OF THE OWNER. I AGREE PLY WIT CITY A STAT S REGULATING CONSTRUC- CALL This application is not a perrnituntil signed by the TION; AND I DOIN HEW AUT RIZED ERE PERSON WILL BE EMPLOYED Building 011icial er hie/her Oopuly: and Fooa are paid, and IN VIOLATON OKTHE OR 400j OF E STAT WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in apace provided. WORKME C PENS N 9ANCE ND RC 7. DATE OFFICIALS SIGNATURE SIGNAT A'GE DATE SI NE (425) r' �. 771=0220 RELEASED BY . JDAAE ATTENTION ) ITC, ��� 71/1 'ULTO GSE OR OC PYAB BbING OR STRUCTURE UNTILAFINAL E 1333 ) 7 IT IS UNLAWF INSPECTION HAS BEEN MADEANDAPPROVALORACERTIFICATE OFOCCU- PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. 19/03 PRESS HARD -YOU ARE MAKING 4 COPIES 1 - FILE YELLOW. INSPECTOR OWNER GOLD -ASSESSOR re A