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20050115.pdfDATE RECEIVED« P.� v PERMIT EXPIRES USE PERMIT CITY OF EDMONDS ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTN OWNER NAME/NAME OF BUSINESS ADDRESS 670 % %� l It \I� PLAT NAM E/S(UB(DIVISION NO. ( LOCT, NO. LID NO. 1pfLL l LID FEE S w MAILING ADDRESS TESCP Approved O �PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit RogWred GlreslL e-Ptir nil Req'd CITY +✓c-' Lice�!/ ✓101��.�jn}`< EXISi`NG SED Inspection R 7qulrod 13 TELEPHONE �ehuired Qriegi Permit Mill RE iCeWidnOregul d 0 $OaREO N� NAME METtS'W�'T PRV • EOUIRED c7 :. �,�. .��..•4: SDt NO ❑ Z w_ ADDRESS REMARKS z x OWNER CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE if j- Two CITY ZIP TELEPHONE nas P,3 : 94 Q NAME} ►b ENGINEERING REVIEWED BY ((. s 'i' _.,f.9 DATE ADDRESS `` h �• n7 l iTi T L FIRE REVIEWED BY m CITY ZIP TELEPHONE O J N.k� l L� q g �• (o g 6 �" Ci49 7 1 e R or I, vent cin»ectnrg required B D STATE LICENSE NUMBER EXPIRATION DATE rQ BY VARI �l .. R 4' Oc7s�0 TED "�j�t,�cJ►.��-1A�` i (�`Z i� `'i ©� through laer�ted xPACe AYES PR//O��P'E^•RRTY TAX ACCOUNT PARCEL NO. ! COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED t✓ lJ i. O 0 t 00 EXP ❑ NEW RESIDENTIAL UMBIN EC LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) 111 ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR LIANCE OR Z ADDITION ❑ COMMERCIAL 13CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE g ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED ❑ REPAIR ❑ GRADING ❑ FENCE X FT) REMARKS coos OTHER ❑ DEMOLISH ❑ TANK ❑ FIRE _ ❑ CARPORT C] WALL GARAGE RETAININGWALL ❑ FIRE ALARM SPRINKLER O (TYP OF USE• BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE ,I N CQQ� OCCUPANT . "til l/�► �/ GROUP n NUMBER NUMBER OF CRITICAL OCCUPANT OF DWELLING AREAS SPECIAL INSPECTION AREA LOAD O STORIES UNITS NUMBER ��'��JJJ REQUIRED [:]YES DESCRIBE WORK TO BE DONE t7 REMARKS PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D 9 u3 � i I� mac. Fll.)IOU NUS 0 Al.t �IP��Cr '1Z ..� VALUATION, bs OETI.`3�'� $ uae� �� i p Description. FEE Description FEE LLTV I kL 6r -A 2A 011;i:5" Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge I , PLAN CHECK NO: VESTED DATE Plumbing % Base Fee r Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading 7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE t SEPARATE PERMISSION. Engr, Review 1C PERMIT APPLICATION: 180 DAYS IL 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 Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 9 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt M ¢ ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landsca a Ins Total Amt. Duo 1 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE p p �� s NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt 0 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 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL IIllsng nppllcnllon le nal n pinmll until Foos by id, TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED OuIWulO 011iclal or hlelhur Deputy: and Fuoo tiro paid, and IN VIOLATION OF THE LA8 CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION tocu4Nisncknowlddgogloepnldptovlddd WORKMEN'S COMPENSATI IN RANCE AND RCW 18.27.1 U IF OFFICIALS SIGN IHf ATURE (OWNER O GE DATE S GNED (425) /l L(�r s 71 1 0220 ilrl FASFI IIV T[ ATTE 4TION EXT 1333 t IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU• ollICIINAI. rn.r vrI Lcxu INSPCCTOH PANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110, I PINK 0`NN(H Got 1) - ASSCSSOH 09/03 PRESS HARD =YOU ARE MAKING 4 COPIES 0