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20050166.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION O ,EP, N EINAME OF BUSINESS It,- C - W MAILING ADDRESS 30: Ll i to�—� CITY ZIP LEPHONE J ADDRESS ❑ NEW ❑ ADDITION ❑ REMODEL ❑ REPAIR ❑ DEMOLISH ❑GARAGE CARPORT NUMBER OF STORIES TELEPHONE i 1 PERMIT EXPIRES �. JP <�_ PERMIT NUMBER -UTO 17.) " l I L•07. JO© '> > SUITE/APT# ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O RW Permit Required 0 EXISTING PROPOSED Street Use Permit Required O Inspection Requited 17 Sidewalk Required O REQUIRED DEDICATION FT Underground O Wiring required 0 METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED YES E3 NOD z w REMARKS w OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z 3 z w ENGINEERING REVIEWED BY DATE i 5r • FIRE REVIEWED BY DATE w ZIP TELEPHONE tr R EXPIR ION DATE CH CKE VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA I�`, REO'D COMPLETED EXEMPT 1 L 00 OYES 0 NO ZONE SIGN AREA HEIGHT NT PARCEL NO. CAp WAIVER M ALLOWED PROPOSED ALLOWED PROPOSED Li STUDY ❑ RESIDENTIAL❑ PLUMBING Y MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR 13 COMMERCIAL COMPLIANCE OR i 1:1MIXED USE ❑ CHANGE OF USE z PARKING LOT AREA PLANNING REVIEWED BY DATE g 25 MULTIFAMILY ❑ SIGN REQ'D PROVIDED 1:1 GRADING ❑ FENCE CYDS ( X FT.) REMARKS ❑ TANK ❑ OTHER ❑RETAINING WALLFIRE SPRINKLER ROCKERY ifFIRE ALARM SS OR ACTIVITY) EXPLAIN: IF r2 NUMBER OF l DWELLING 1 UNITS 04/ VORK TO BE DONE 6461 Yf E OF CONSTRUCTION CODE OCCUPAN GROUP !a7 LCIZ4 SPECIAL INSPECTION CONSULTANT IJCCUPANT REQUIRED C YES LOAD DCIAADW71 iii, 0 z O 1 BYiJll4cm STRUCTU DESIGN j BY: VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit City Surcharge Zu PLAN CHECK N 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 SEPARATE PERMISSION, Engr. Review w PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5) a PERMIT LIMIT: SEE ECDC 19,00,005(A)(6) Engr.. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION w"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review l``) Plan Chk. Deposit 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 # 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 # 1 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 perrnil until signed by the 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 CALL Budding receipt or his/her Deputy and Fees aro paid, and IN VIOLATION OF THE LABOR C OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION fe1t i5 aeknowlsdgud m space prowdeA WORKMEN'S COMP SATION IN CE AND RCW 16:27. OFFJC S SIGNATURE DATE SIGNATOR (OWNER EN DATE SI NED (425) ` J CJ l LLlql6q � ' 771 =0220 RELEASED BYE DATE ATTENTION EXT. 1333 ev�' n IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 7 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE •YELLOW -INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110, PINK -OWNER GOLD • ASSESSOR 10104 PRESS BARD = YOU ARE MAKING 4 COPIES z 0 n m C M --I O O C _M mZ ID M1 Ciiiiiiiiis z �CY) wn mm_ O� r- rOM Cn ! Z m� • D X 2. D z z O n M