20050100.pdfDATE RECEIVEImmdE- d
_. PERMIT EXPIRES
RMIT
(CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB s ITEIAPTN
ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO LID NO
W
MAILING ADDRESS LID FEE 5
Z/ � PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAPo TESCP Approved O
3 r RW Permit Required E3
Street Usu Permit Requited 13
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required O
Sidewalk Required 0
C. ` L % ? G' REQUIRED DEDICATION FT underground O
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
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ADDRESS REMARKS W
u OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
Q W
CITY ZIP TELEPHONE
NAME CBL9
Ifi-LQ Q,( -. Ci. 't v 1 C f ENGINEERING REVIEWED BY DATE
Ix ADDRESS
U
rt FIRE REVIEWED BY DATE W
Z CITY ZIP TELEPHONE cc
STATE LICENSE NUMBER EXPI TION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBt1 INSPECTION SEPA
( REO'D COMPLETED EXEMPT
OYES _ Cj L��1 DHr�c� 5361- I ES ONO
C4 ZONE SIGN AREA HEIGHT
PROPERTY TAX AC OUNT PARCEL NO.
Q r `� /� - WAIVER O - ALLOWED PROPOSED ALLOWED PROPOSED
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��. 4 61.-4 ,;. 0 ,-)l(i - C'o6 STUDY O
❑ NEW RESIDENTIAL PLUMBING/ MECH . LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
51 ALLOWED PROPOSED, FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE -•.• -P �jy�R�yj�{� n u
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D A ry{pWtf :Caf E V It�A l (1Y�I1C�-�"" f'requi. g
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REPAIR GRADING FENCE �_ A- �n
❑ ❑ CYDS ❑ ( X FT.) REMARK
1.1, C 803.2
OTHER 1ItL:1.1 t1 .ri 3154 4`g. s+�'
❑ DEMOLISH ❑ TANK 11:11111111 11 RAN
GARAGE Z ❑ CARPORT ❑ ROCKERY G WALL FIRE ❑ FIREALARM LER
(TYPE OF USE, BUSINESS•OR ACTIVITY) EXPLAIN:
IL "-" TYPE OF NSTRUC `ION CO OCCUPANT
IL 1 ^ ( f GROUP ij
cNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
REQUIRED 13 YES
DESOf IBE WORK TO BE DONE
v \ Lc tt. REMARKS Z
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GEOTECH REPORT gg�� L r. v m
BY: P r
ECTOR
e(.0 C C.S STRUCTURAL DESIGN qtr"ALL 1,t T
lA\ _ 1 BY: a3 I� +1 e y
6r - c C L' - ( _eokt VALUATION .e, Z T iJ
t5 $
`r l lbJ Description FEE Description FEE
11
• Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge 61`�
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. Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
w 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
C DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due,. ~
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt # 1_J j
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. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her 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 to space provided
WORKMEN'S COMPENSATI.INSURANCE AND RCW 18:27.
�iI \ FFI h�LS SIG TRE DATE
` DATE SIGNED
SIGNAT RE (OWNE O .AGEtJ ): (425)
771w0220 -0220 RELEASE BY
ATTENTION EXT. 1333
Ir IQ I Iw Awcl11 m I ICF nR nrri IPY A RUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW INSPECTOI
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC110I IRC110. PINK -OWNER • GOLD ASSESSOR.
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