20050087 (2).pdfDATE REC7°-FD -
2Z, 2je�T [PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTH
ADDRESS
OWNER NAME/NAME OF BUSINESS S/
PLAT NAMF.ISUBDIVISION NO. LOT NO. LID NO,
MAILING ADDRF.S LID FEE S
W _
3 .� i l L� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TEscPtu van O
O , V /� RW P er Roqu red IJ
CITY ZIP TELEPHONE EX _ pucuon Raqufrod O
7 'c�rToei;:0`!�"D Y'A"T(C �' j ,U;��i LB °a
L, n� r'%..i7 -� Z� C7 Ll �S — / �� ���� L( R EbT bI L
F ft O
T 4zNAME T TEEI) 1 iilhh lyEil J'L O.OILF 4Q4J 'kWfYEhVFtEbP
Tii� i'iIERE ETA WATL RYFSfiRvAQ5
W
ADDRESS O EFNCbNTt7AC AR R ONSIDLE F� ROI O A =
Q
CITY ZIP TELEPHONE Vjpj;r C47 T R 'r
A Air
t p TA f_ EI FC
Cal CAL PERMIT AND
NAME CBC �/1. AL
!•l:C71 IS REQUIRE ELE
(7C O C C I 1l.(.N.'J L EN INE& e{'f�%r, pp�•� np
m ADDRESS Q111''1' V1:� �i AVLEU �`�1V 1,�C • +�✓
O P
U O V v FIR R %N BILA!
�••� 4 t ry
Z CITY ZIP TELEPHONE DIVI. ION 112 42•x'2904 709
STATE LICENSE NUMBER EXPIRATION DATE C CKED A N INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
(' j/1 i i�� `h�
113YES NO
7 /J t0
3
CA# ZONE SIGN AREA HEIGHT
PROP RTY TAX ACCOUNT PARCEL NO.
WAIVER 13ALLOWED PROPOSED ALLOWED PROPOSED
W
STUDY 1
❑
NEW RESIDENTIAL p GING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
U;MOI�X
MERCIAL COMPLIANCE OR i
ADDITION❑CHANGE OF USE zED USE PARKING ' LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
Rs 3 i
GRADING FENCE
:IJI 1'Q IJPC: 6N
❑ REPAIR ❑ CYDS E]( X FT.) REMARKS >,TX)AVALyE(pidVj
❑ DEMOLISH F1TANK ElOTHER
/ J
GARAGE RETAINING WALL FIRE SPRINKLER 1171WATERSMILITOFF
O ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
n (TYPE OF USE, BUSINESS OR IVITY) EXPLAIN:
{ v C/�� TYPE O MTRUCTIO CO OCCUP
aNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
to STORIES UNITS C..// LOAD
0 REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
BC 605
C 1/ Vv GEOTECH REPORT PURS-11ANX X0 ` '
BY: A WATER SERVICE SHUTOFF
STRUCTURAL DESIGN
BY: ;
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% j____VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee ✓
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
�- BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
2 Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
LU PERMIT LIMIT: SEE ECDC 19,00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
N •APPLICANT; ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire ReVIBW Plan Chk, Deposit
LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i 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 Fee Receipt #
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 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hislhor Deputy: and Fees are paid, and
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 FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OF ALS SI)3N TURE DATE
SIGN (OWNER 0 G NT): DATE SIGNED (425) f ��5
0/ d 771m0220 RELEA D 6Y DATE
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- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 / IRC110, PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
r
Z
0
m
Cl)
2
ern
M0
O
O
n
==I
K
r