The URL can be used to link to this page

20050194.pdfDATE RECEIVED PERMIT EXPIRES OERMIT CITY OF EDMONDS NUMBER � G1 CONSTRUCTION PERMIT APPLICATION JOB/• SUITEIAPT# 11 tV( ADDRESS'10 �\ ` l \ i OWNER NAME/NAME OF BUSINESS % i4/J L t� /ate/ %) � �7 V11V K S PLAT NAMEISUBDIVISION NO. LOT NO. LID NO Lu MAILING ADDRESS '` �/l l�4 /// LID FEE S z ` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP O RW Permit Required 0 Street Use Forted Requited CITY ZIP TELEPHONE EXISTING _ PROPOSED Inspection Requited O Sidewalk Required D rA � pp� k e L REQUIRED DEDICATION FT underground Q V i^G � `V � � - _--- Wmn re wroC t7 NAME METER SIZE LINE SIZE 70. OF FIXTURES PRV REQUIRED / YES 0 NO O z W t �c r.� W i AD RESS REMARKS W U ' r t� v 41111,``LO ya OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP TELEPHONE r) nw co to 9 D 3 S', D'- 61 . NAME CBLp OwG ENGINEERING REVIEWED BY DATE im- Io ADDRESS { I 7y' tllo �I --t ), i i FIR W BY DATE Lu Iz-O r CI . ZIP TEPHONE 1 /1/0// O` a -1Z 0 STATE LICENS NUMBER EXPIRATION DATE D 8Y' V IANC& OR C SHOR LINE OR ADEN INSPECTION SEPA REQ'D COMPLETED EXEMPT i j�7 l 4e- r 1E3YES Gal PROPERTY TAX ACCOUNT PARCEL NO. ! CA# ZONE SIGN AREA HEIGHT Q �J . WAIVER D ALLOWED PROPOSED 'ALLOWED PROPOSED / 5• DO a d D G V STUDY o +'C' NG, NC, ❑ NEW ❑ RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR COMMERCIAL COMPLIANCE ORz ❑ ADDITION ❑ �. r " t' z 13 PARKING USE CHANGE OF USE z ❑ PARKING LOTAREA PLANNING REVIEWED BY DATE ❑REMODEL g MULTIFAMILY ❑ SIGN REO'D PROVIDED FENCE N� Z X24 ❑ REPAIR El CYDS ❑ ( X FT.) REMARKS ❑ DEMOLISH 13TANK .IT ITVR, z ❑GARAGE RETAINING WALL 1� FIRE SPRINKLER CARPORT ❑ ROCKERY ❑ FIREALARM 0 a (TYPE OF USE, BUSINESS ORA TIVITY) EXPLAIN: TYPE OF CONSTRUCTION. CODE OCCUPANT GROUP cNUMBER NUMBER OF OF DWELLING^ SPECIAL INSPECTION CONSULTANT OCCUPANT o STORIES UNITS / `/ LOAD REQUIRED YES DESCR BE WORK TO BE DON lam© t} L �511fLA-b (=I REMARKS z r V % %'t oQ 1 eu a-< 4f) GEOTECH REPORT � BY: y.� rn I V l/ C t� li �tiC \. ' �R�1 v4 . IF STRUCTURAL DES��IG�C. QC� E Imod C C ct 17:. VALUATION Description FEE Description FEE Plan Check 1 / State Surcharge 14 so HEAT SOURCE LOT SLOP % VESTED DATE 11;14 Building Permit � City Surcharge � PLAN CHECK NO: Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK_TO Mechanical It: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g t SEPARATE PERMISSION. z Engr. Review ILL! PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection rn •APPLICANT• ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review /J Plan Chk. Deposit U' 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 # j 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 7 = NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt #11111111 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 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 THEW -4UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE BOR ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPE AT SURANCE AND RCW 18:27, OFF G! SIGN RE DALTE sl EO GENT): DATE SIGNED G/ f (425) 1 a] 77`1 0220 IIELEASED AT A TENTION EXT. 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL �v O A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINA E YELLOW - IN PECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109I IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES 0 m cM v M o On _ M mZ p Dz r= mn I tern ON n m C N f Z D. Z 0 O m