20050143 (2).pdfRECEIV[U —� L
PERMIT EXPIRES i;7
PERMIT
CITY OF EDMONDS NUMBER `2—c'r
CONSTRUCTION PERMIT APPLICATION ADB ' �l SUITEIAPTu
ADDRESS/nom � }!I/� /� �
OWNER NAMEINAME OF BUSINESS
&Loliz Kk 4...�G PLAT NAMEiSUBDIVIS10N NO. LOT NO LID NO
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MAILING ADDRESS F\ LID FEE S
-- PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O
O ? � � r 4�C., RW Permit Required 0
Street Use Permit Required 0
CITY ZIP TELEPHONE EXISTING PROPOSED_ Inspection Required O
���* S,deualk Required 0
eDM0 JO LJ-) i W?0 4Z5~ V y y3 0 . REQUIRED DEEWATI�&INS _ Underground 0
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NAM METER SIZE • S l K BE oCL13ANED . FYPARIS NO 13 _
W TURES I PRV REQUIRED
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t ADDRESS REMARKS :Sid MUST �� �D " W
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CITY ZIP TELEPHONE
bzIN'✓('L9 WA- �% 12 „t �- —IL,t� y HOSE 819 WITH AVB INSTALLED
NAME CBL a • DUMP AT APPROVED DUMP SIZE ONLY
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`SDN N ENGINEERING RE" ftft vDEMOLITION INSPECPIOWTE
tY ADDRESS
o, • CHECKLIST ON BACK. OF JOB CARD
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UFIRE REVIEWED BY TION 4
ZIP TELEPHONE
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U Iv cull �l �07�0 2M 6/ 9?
STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADBp INSPECTION SEPA
REQ'D
%�/� `-0160
_ COMPLETED EXEMPT
I.3W � CJ / �w/0 YES NO
CAp -- •ZONE SIGN AREA HEIGHT
-x PROPERTY TAX ACCOUNT PARCEL NO.
Q WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
ase y3 q •Z oy bo all oo STUDY 13
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
El COMMERCIAL COMPLIANCE OR z
El 1:1 ❑ CHANGE OF USE i
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
[3 REPAIR ElCYDS GRADING ❑ FENCE
( X FT.) REMARKS
DEMOLISH. ❑ TANK ❑ OTHER
Z 1GARAGE RETAINING FIRE
:1CARPORT ElROCKERY WALL ❑ FIRE ALARM SPRINKLER
a(TYPE OF USE, BUSINESS OR ACTIVITY LAIN:
TY]2 T N OCCUPANT ,+'7
u �� /1 GROUP
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NUMBER ! NUMBER OF ' �r�
OF 1 DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
o STORIES . UNITS LOAD
-r REQUIRED OYES
DESCRIBE WORK TO BE DONE
REMARKS i
10 PR. /N
t* OLI S fA GEOTECH REPORT m
_ BY:
STRUCTURAL DESIGN
BY:
VALUATION
Q Description FEE - Description FEE
) Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE ✓
Building Permit ' � 2` 1 City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
f
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION,
Engr. Review
Lu PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5) I
IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection '
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U)•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Uj 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 #
z 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.* n �; ��
Recording Fee Receipt # F
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 his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in ace provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO p 9 P
WORKMEN'S COMPENSATION I SURANCE AND RCW 18:27. OFFICIAL SI NAT DATE
NATURE (OWNER O ENT): DAT SIGNE (425) J I L /� �O
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771-0220 IRE LEAS D Cly
or
ATTENTION EXT. 1333
IT IQ I INI AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE a YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC110 I IRC1101 PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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