20050182.pdfDATE RECEIVEg•
PERMIT EXPIRES
CITY OF EDMONDS ZONEL
' PERMIT s �`
� ,% NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ITE/APT#
ADDRESS <? j)
OWNER NAME/NAME OF BUSINESS :•S
PLAT NAME/SUBDIVISION NO. ttT NO. LID NO.
MAILING ADDRESS LID FEE f
-�' .y.. TESCP Approved Q
Z3 % /119
L s�� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required p
CITY „'TIinspection RequireStreet Use Permit d
O
ZIP TELEPHONE EXISTING '�— PROPOSED— i 13
_ Sidnwelk Required � �
' yf REQUIRED DEDICATION FT Underground
�iJDo AY WA 9 40& 3 y� J l • I wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
LA /'`I/�5Gd/ZD ArS/y A/ /+S5d 4r.A4 1065 .!�/�!�' r 3 / 1 1 / 1 I . YES ❑ NO ❑
ADDRESS REMARKS =
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
130,5 iJ te" A VEr
CITY. ZIP TELEPHONE I N / N ?t4 r
jp0jeu;d! a 9�v�� �s- i�04COCIN001, a _
NAME I CBL q r� —
'V / G / IQ ENGINEERING REVIEWED BY DATE.
DRESS
" ' FIRE REVIEWED BY DATE W
CITY ZIP 7TLEPHONE
�y�••11 WVLV��lLIA� r�D �'�� VARIANCE OR CU SHORELINE OR ADBp INSPECTION BOND
STATE LICENSE NUMBER XPIRA ON DAT C �CKED Y REO'D POSTED
L 6�t / OYES VNO $
D f SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
0� D Ott EXP
® NEW RESIDENTIAL ® PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR
CHANGE OF USE 3SY0 ac)1 15, ( 1 , I , 1 - y
❑
REMODEL MULTIFAMILY PARKING LOT AREA PLANNING REVIEWED BY DATE 5 ❑ ❑ SIGN REO'D PROVIDED Com(, C �� a
FENCE Z. 1 ✓V"1• J
❑ REPAIR GR ❑
CYDS ( - X FT) REMARKS
❑ DEMOLISH ❑ TANK ❑ .OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
ii CHF,CKED BY TYPE TION C OCCUPANT
GRO
NUMBER NUMBER OF CRITICAL
OF DWELLING j AREASJ� SPECIAL INSPECTION A EA OCCUPANT
STORIES UNITS NUMBER V� REQUIRED ❑ YES LOAD
DESCRIBE WORK TO BE DONE r
REMARKS i
PROGRESS INSPECTIONS PER 111 108 IBC109 / IRC109 FINAL INSPECTION REO'D 9
•4 V5
444210
115 4+
AJ 0
VALUATION
1AAv t pepeN 60 ks'4
Description FEE Description FEE
Plan Check ` State Surcharge J ;
HEAT SOURCE LAZING LOT SLOPE Building Permit City Surcharge
6A5 u MA iF ,
wr
PLAN CHECK VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
C BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC j
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Lu 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 1W.99 III
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 LandSCa e InS 'tJ
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P P• Total Amt. Due v�ll
= NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # ��•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the VTION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S CO SAT I(JSURANCE AND RCW 18.27.
FFICIALS SIGN URE DATE
U (
SIGNAT0 / R O E DATE SIGNED (425) , j
el
771-0220 '
R L A ED BY ATE
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCU PYA BUILDING OR STRUCTURE UNTILA FINAL
t: INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL •FILE YELLOWGD- INSPECTOR
ASSESSOR
.
09103 PINK -OWNER GOLD •ASSESSOR .
PRESS HARD =YOU ARE MAKING 4 COPIES
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