20050091.pdfDATE RECEIVED I
I cc�,10 [PERMIT EXPIRES
'PERMIT
CITY OF EDMONDS NUVIBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
ME lo 5-d
FOWNLER NAME/NAME OF BUSINESS Avc- �5 -
LII � , . < FLAT
�,-: . � (2 i� - NAME/SUBDIVISION NO. LID NO.
1\ "'11 __�::�(41\ V .1
MAILING ADDRESS
1
CITY ZIP TELEPHONE
-7LI j,-3 35
NAME
=1411i
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIPApproved [3
0
RW Permit Required
Street use Permit Required
EXISTING PROPOSED
Inspection Requited 13
Sidewalk Required El
REQUIRED DEDICATION FT
underground 13
Wirinq required
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
YESO NOU
z
REMARKS
Tj
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 15
2:
I
@u
t-) oi-_ C-0-5 Svc,
I V1
ENGINEERING REVIEWED BY DATE
m
0
1,_
U
ADDRESS
U14"I 93
FIRE REVIEWED BY DATE
w
z
0
U
CITY 71P
LIQ PA. 9
TELEPHONE
aoG -- -7,8q - G 1 (3 k
VARIANCE OR Cu
SHORELINE ORADB#
INSPECTION
REO'D
13 YES R'NO
SEPA
COMPLETED I EXEMPT
VOOO
UMBER EXPIRATION DATE
G oc fjLco
GUCKED BY
CAN dXtjVk
WAIVER 13
STUDY 13
ZONE
06
SIGN AREA
ALLOWED I PROPOSED
IVA
HEIGHT
ALLOWED , PROP OSED
2
w
PROPERTY TAX ACCOUNT PARCEL NO.
A7o 3,13 oacto `/oo(3
NEW RESIDENTIAL PLUMBING f MECH
ADDITION 19 COMMERCIAL COMPLIANCE OR
MIXED USE 1:1 CHANGE OF USE
El REMODEL MULTIFAMILY 13 SIGN
GRADING FENCE
REPAIR 1:1 CYDs 1:1 X FT.)
OTHER
DEMOLISH 0 TANK 0
LOT COVERAGE
ALLOWED PROPOSED
I NL
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
z
z
z
PARKING
REQ'D PROVIDED
A) ii�,
LOTAREA
PLANNING REVIEWED BY DATE
-7
REMARKS
V
z
GARAGE [3 RETAINING WALL [3 FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
U
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
QaAY�,'�raAA\
TYPE CLIF CONSTRUCTION
CODE
OCCUPANT
iGROUP
V)
UJI
0
7
NUMBER
OF
STORIES
—FE—SCRIBE
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTION
REQUIRED 13YES
CONSULTANT
OCCUPANT
LOAD
WORK TO BE DONE
REMARKS
z
C�a&�- -01Jr -H-..Jn
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
Flec. .-Hev*
LOT SLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
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
2
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
U)
U)
W
2
9
0
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SU CCESSORS
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 ORDINANCE
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
K5
Recording Fee
Rece pt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM T14E 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 LABOM CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT)KINNIRANCE AND RCW 18:27.
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DAT
(425) Sn o��
-0220 RELEA D dy AT E
771. A
SIGNATUREN OR,
Z
DATE SIGNED
-2
EXT. 1333 7--__
11 A., 117fi 1 4;
Itw - - -
ORIGINAL!,AILE YELLJW - INIPECTOR
PINK -OWNER GOLD - ASSESSOR
ATTE!"itTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEIRTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110.
10104 PRESS HARD - YOU ARE
MAKING 4 COPIES
z
0
0
M
Om
C
MO
0
—11 0
0 C
3: M
M Z
C _z
0 _n
M M
0
0 M
C Cn.
C Cn
M 0
Z
z
CD
z
0
11
0
M