20050180.pdfr
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DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
UM ER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS r+
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OWNER NAME/NAME OFF13U�SINESS /1
COMM UN1 I / yT C H R IST14M MI'LOWs N / P PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
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MAILING ADDRESS LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproyod CI
O A d. 90X S50 RW Permit Required 0
Street Use Permit Required Q
CITY ZIP TELEPHONE EXISTING __- PROPOSED inspection Required O
6 0 MONOS 9 0 0 ZQ D 1 &o REQUIRED DEDICATION _ _ FT _
Sidewalk Required O
yam_ 7`1// _ Unringrequitl CI
! -1 VJem required 0
NAME METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
,gRow��ElT PE7�7LSOF/ H9rr,Mt?Z 02CH. YES DNOM rere
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� ADDRESS REMARKS z
_ OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE
LYAlAIW 00 9bo36 y2S- 774 (1701
NAME CBL#
ENGINEERING REVIEWED BY DATE
nG ADDRESS
/ J FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
10YES CI NO
CAO ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. ( WAIVER O L o OSED ALLOWED PROPOSED
W Z763 Z 00 Z Z I S O D STUDY O
RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUI SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ NEW ❑ ❑ ALLOWED PROPOSED NT SIDE REAR FRONT UR SIDE REAR
® COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑ CHANGE OF USE Z
❑ MIXED USE I
PARKING LOTAREA PLA ING REVIEWED BY DATE
MULTIFAMILY g
REMODEL SIGN P IDEREQ'D D
❑ ❑ ❑
FENCE
❑ REPAIR 13GRADING CYDS ❑ ( X FT.) REM
❑❑ ® I NT�7LIOk DEMD I �' rP
DEMOLISH TANK J _
GARAGE RETAINING WALL FIRE SPRINKLER 4ee ' o,h� n rr '4 -
Z ❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM V
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(TYPE OF USE, BU NESS OR ACTIVITY) EXPLAIN: J
a TYP OFC' T UCTION CqD$ OCCUPANT
V C//11 JJ GROUP
I 40
w NUMBER NUMBER OF
OF DWELLING; SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES / UNITS LOAD
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
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k mot)A -(� OF WIW40 ^4/Y16D�j%f A !"Mlo$ GEOTECH REPORT m
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Description FEE Description FEE
662E- 4IT771GCH62) Ho7ZF3 tf *4L*N Plan Check Stale Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE /
Building Permit tl�% . City Surcharge
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
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
dd I=Engf. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
CL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
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'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
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 # /
IL
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-
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 in space provided.
WORKMEN'S COMPENSATION I RANCE AND RCW 18:27.
OFF (GNAT R DAT
SIGNATURE(OW G O D TEZ —VU;i .(425) !.
771m0220 0220 J -AS ED BY DATE
ATTENTION EXT. 1333i J
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
14
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE •YELLOW -I SPE TOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110. PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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