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20050014.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINE S F�11 V/EtAl ARSTHc�jt� MAILING ADDRESS 1 0 - J I✓ izGREE 044' CITY SFr7oNE ��o2-1 I ? NAME ADDRESS ADDRESS H CITY "I lire 01 �— f.w ;, PERMIT EXPIRES 7 PERMIT r NUMBER�1L� JOB SUITEIAP-T#1 C ADDRESS / CE•, j>Ho tJb > PLAT NAM EISUBDIVISION NO. LOT NO. LL LID NNOO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0 RW Permd Roqu I� street use Perrnd Required 133 EXISTING PROPOSED Inspection Required O Sidewalk Required REQUIRED DEDICATION FT Underground O Witing required E3 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NO O _ w REMARKS w OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z (7 1070le . 6 460 CBL# JV l�U-%L'f� C • G/�/ 22.� Y DATE r owmy I LI VE bhA, ZIP TELEPHONE rn� rxL � 2/ `} h-� ItiIM- LA 4 u48/8g � �0 y� I STATE LICENSE NUMBER EXPIRATION DATE CK BY "8911 INS TION SEPA f / �Yj _ REQ'D COMPLETED EXEMPT l_ Y" YES NO CA otlZO SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. WAIVER13 ALLOWED PROPOSED ALLOWED PROPOSED W �j c (,/ (�.' STUDY Ia ❑ NEW ❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t, El COMPLIANCE COMPLIANCE OR z ❑ ADDITION 13 CHANGE OF.USE z ❑ MIXED USE . PARKING LOTAREA PLANNING REVIEWED BY DATE ga ❑ REMODEL jR:6iIULTIFAMILY ❑ SIGN REO'D PROVIDED GRADING FENCE ❑ REPAIR ElCYDS ❑ ( X FT.) RVAt'i/ `- OTHER ' ❑ DEMOLISH ElTANK 13 GARAGE ❑ RETAINING WALL13FFIRE SPRINK IREA ARM LER ✓(, T Z ❑ CARPORT ROCKERY N1.✓ a 3) 11ILM &, L40eLlwAlm e (TYPE OF USE, BUSINESS O AC IVIITY) EXPL IN: NUJ TYP '/% N GROUPANT U�. V ut 11 NUMBER MER F C OF 2 JtEBLLING� SPECIAL INSPECTION CONSULTANT OCCUPANT O STORIES ✓ UNITS LOAD 0 REQUIRED D YES DESCRIBE WORK TO BE DONE REMARKS i 1N - Lac PI PE R15io k4TT/ o tJ B4. / f1tc� /s,4 oX EPox�'E: IoA'— /J ` »F � �,✓ ,l/OMiI= C. W1L� RISES ' .AIu�N VALUATION V /-' Description FEE Description FEE l �, %, `� Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE ` Building Permit City Surcharge PLAN CHECK NO: Plumbing �' j — Base Fee r THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MCChanICBI BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE. g SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Ile PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection Go "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 :E 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 ` O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' _ Recording Fee Receipt # 1 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 This application is not a permit until signed by the THE OWNER. I REE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Foes are paid, and TION; AND IN I G THE WORK AUTHORIZED THERE NO PERSON WILL BE EMPLOYED IN VIOLATIO O THE LABOR CODE OF THE S OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'SO PENSATIO RANCE AND W 1 :27. OFFJ6IALS IGN URE ATE SIGNAT 0 NER 0 GENT): DATE SIGNED (425) ��J�--�� I 'r 771 -0220 RELEASLt BY DA TE ATT ON EXT. 1333 ---_ IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTla ORIGINAL •FILE YELLOW -INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC110 I IRC110. PINK -OWNER • GOLD - ASSESSOR 10/04 PRESS HARD - YOU ARE MAKING 4 COPIES