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20050078.pdfr .• DATE RECEIVED _ I _/ r�)? CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWJE� NAME/NAME OF IIIUSINESS OI V' 011 AU CITY NAME µ�WI C ADDRESS VVQ a CITY ZIP TELEPHONE ZIP ITELEPHONE I I PERMIT EXPIRES Tjp4, Usil ZONE PERMIT - - NUMBER 1I �� L� JOB SUITE/APT# ADDRESS A /^ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RApproved RWW PP Permit Required a [J Street Use Permit Roq'd o EXISTING PROPOSED Inspection Required 13 Sidewalk Required E3 REQUIRED DEDICATION Fr Underground Wiring required O METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED O YES ❑ NO ❑ Z Ww REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5 Tr x ,NE I �/ CBL p eyl1� � 1 b1 yy� ' nl ip/s f . (,v 1 k. 5ery(c V 91 9 �j ENGINEERING REVIEWED BY DATE ¢ ADDRESS '� �' r�" - / c5LU C- C k FIRE REVIEWED BY DATE w CI ZIP TELEPHONEs O 11: 0 00 VWORSE ARIANCE OR CUV1, C) eECTION BOND STATE LICENSE NUMBER EXPIRATION DATE C BY POSTED )I TS 9� Fi.l 71 �) o� (J i iii SIT S� PRES S J SEPA RE'� T tA�D'"'PRt?F��ED 'ALL`ONeD EIG PROPOSED PROPERTY TAX .ACCOUNT PARCEL NO. COMPLETE jPt V o EXP ❑ NEW RESIDENTIAL 13 ALLOWED / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR r, ❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR F1 CHANGE OF USE Z PARKING LOT AREA PLANNING REVIEWED BY DATE a ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED ❑ GRADING FENCE REPAIR ❑ CYDS ❑ ( X FT) REMARKS ❑ DEMOLISH TANK ❑ OTHER GARAGE RETA❑ FIRE CARPORT ❑ ROCKIERY NING WALL ❑ FIREALARMKLER (TYPE OF USE, BUSINESS OR A IV XPLAIN: CHECKED BY TYPE OF ONST TION C D OCCUPANT i GROUP NUMBER NUMBER OF CRITICAL m OF DWELLING AREAS SPECIAL INSPECTION AHA OCCUPANT /%� LOAD io STORIES UNITS NUMBER l/ REQUIRED O � ❑ YES DESCRIBE WORK TO BE DONE REMARKS I 1 Or PROGRESS INSPECTIONS PER UBC 108/FINAL If^PECTION REO'D 9 m � ,f $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % •�" Building PermitCity Surcharge PLAN CHECK NO: �.._� VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO It= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. a Engr. Review W PERMIT APPLICATION: 180 DAYS AL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fife R@VIEW Plan Chk, Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt a ` ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY S FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Ir1Sp. Total Amt. DU@ = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' MENEM Recording Fee Receipt N 'O - t2 76) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATIONAPPLICATION 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowlodged In space provided. WORKMEN'S COMPENSATION SURANCE AND RCW 18.27. OFFICIALS'SI ` TU DTE SIGNATU WNER O ENT) DATE SIGNED (425) / �► 4� -w 771'0220 RELEASED BY ATE /J 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 CERTIFI- ORIGINAL FILE •.YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD =YOU ARE MAKING 5 COPIES GREEN • ACCOUNTING 0 m cM M 0. �I O O C 3:M mz p � DZ r = mDm_ O (n M z� Zn X D i Z Z O M n M