20050029.pdfFDATE —RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP TELEPHONE
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NAME
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STATE LICENSE NUMBER EXPIRATI9N DATE I CVMKEP B
PROPERTY TW ACCOUNT PARCEL NO
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PERMIT EXPIRES
PERMIT
NUMBER 4j
JOB
ADDRESS
SUITEtAPT9
PLAT NAME/SUBDIViSION NO.
LOT NO
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LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Required
EXISTING PROPOSED
Inspection Required
Sklawalk Required
REQUIRED DEDICATION FT
Underground
Ming required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIR
D
YES 13 NO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED EXEMPT
E3 YES E3 NO
SIGN A
CA# ZONE 7R REA HEIGHT
WAIVER 13 ALLOWED I PROPOSED ALLOWED PROPOSED
STUDY 13 1 1
NEW RESIDENTIAL MECH
9ED
ADDITION 0?rO MMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
OIREMODEL MULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
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PARKING
REQ*Do PROVIDED
LOTAREA
PLANNING REVIEWED BY DATE
15
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REPAIR GRADING FENCE
CYDS ( X FT.)
REMARKS
OTHER
DEMOLISH TANK
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE OF CAOSTRUCTION C1 NNT
SPECIAL INSPECTION CONSULTANT OCCUPANT
LOAD
REQUIRED 13YES
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NUMBER
OF
STORIES f/
NUMBER OF
DWELLING
UNITS _0411211T
DESCRIBE WORK TO BE DONE f
REMARKS
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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VALUATION
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Description
FEE;
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPES/6'
�IESTED DATE
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Building Permit
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City Surcharge
PLAN CHECK NO-
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Plumbing
Base Fee
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR S
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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC E
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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_
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 COMPENSATION INSURANCE AND RCW 18:27.
APPLICATION APPFZOVAL
This application is not a parind until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIAL IGNAT DATE
(426 50 11 1 /
771-0220 RE - EDBY, DATE
LRE( W2LGE�TfL,, DATE SIGNED
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 if IRC110-
10104 PRESS HARD - YOU
EXT. 1333
ORIGINAL YELLDIN 11,1.1ECTOR
PINK -OWNER GOLD - ASSESSOR
ARE MAKING 4 COPIES
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FINAU.PR63ECT APP ROVALFORM
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DEPARTMENT OF BUILDINGS
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of (Ott an
PER International Building Code Section 110
5th
At: 210 Ave S. Suite 202
Building Permit #: 2005-0029
Occupancy established by this certificate: Dwelling Units: IN/A**
No. Stories: I
B
Type Construction: VA Basement: No
Maximum Occupant Load **9**
(Per IBC 1004)
Room capacity signs, when required, must remain posted at all times,
Owner of Building: 210 51h Ave Buildina Address: 5th
210 Ave S, Suite 202
THE Country Wide Home Loans_HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH THE REQUIREMENTS OF THE 2003
EDITION OF THE INTERNATIONAL BUILDING CODE AS
ADOPTED BY THE CITY FOR THE GROUP AND DIVISION OF OCCUPANCY AND THE USE
FOR WHICH THE PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this 8th day of February 2005
CHIEF. BUILDING OFFICIAL
BY: —
This certificate shall be posted In a conspicuous public area and shall not be removed,
mutilated or obscured and shall be maintained in legible condition at all times. Any change of occupancy or use requires abuilding permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
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