20050204.pdfDATE RECEIVED
3— [PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER Q00
CONSTRUCTION PERMIT APPLICATION JOB UITE/APTH
ADDRESS?Z,—L7
OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
W MAILING ADDRESS LID FEE S
z TESCPAPprovea CI
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
tj RW Permit Requiiod
Street Use Permit Required 13
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required E3
E3
Sidewalk Required
j 60, underground 0
fellre"Nel 412,,j- -07 7� 7 -70 REQUIRED DEDICATION FT CI
...
NAME
METER SIZE
L'GA'S PIFETHTX
jWrWacEQU,RED
imp%iftrnflirgh
N013
z
U
E
1JU
z
[5
lu
I-
x
ADDRESS
REMARKS UVaEnw`
OWNER/CONTRACTOR RESN=VUj!M1OSj4AtjL/MGTGE
L)
z
W
CITY ZIP
TELEPHONE
BE ACCEPTED
NAME
ENGINEERING REVIEWED BY DATE
ix
0
ADDRESS
U
(12- 16" Ile
FIRE REVIEWED BY DATE
LU
CITY ZIP
')
LI q 4f
I
TELEPHONE
- —
I "
z
0
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
113YES
SEPA
COHPLETED EXEMPT
STATE LICENSE NUMBER EXP'RAT'ONr DATE
CHECKED BY
I G::_J_ei_710S
C3 Nol
CA#
ZONE
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
-J
<
WAIVER13
ALLOWED PROPOSED
ALLOWED PROPOSED
UJII
/%,— ) no too 0
STUDY 13
_j
NEW
RESIDENTIAL
LOOM%
PLUMBING ir MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE - REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
ADDITION
El COMMERCIAL
COMPLIANCE OR
OF USE
I
I � I
LD
z
z
z
EMIXED USE
l
CHANGE
PARKING
LOTAREA
PLANNING REVIEWED BY DATE ..
:5
CL
Lj REMODEL 13 MULTIFAMILY I Lj SIGN
REO'D
PROVIDED
GRADING FENCE
REPAIR CYDS ( X FT.)
REMARKS
DEMOLISH TANK E] OTHER
z
UJI
E]GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TYPE OF CONSTRLACT12
C61E�
OCCUPANT
GROUP
NUMBER
ROF
C' OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES NITS REQUIRED LOAD
DESCRIBE WORK TO BE DONE —LUIN,
REMARKS
EGEOTECH REPORT
BY:
STRUCTURAL DESIGN
A BY: LUATION
I j pt It :i1i'dAY6 I Art, $
144
Mill
ij It A-.VR I k V
1) (Ut_Ljyitr\ Description FEE
Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Pe rmit
CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
0: PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
did
06 PERMIT LIMIT: SEE ECDC ig.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Description
State Surcharge
City Surcharge.
Base Fee
FEE
0
z
C3
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
In
Uj
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGEN rS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a IFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
i DEEMED TO MOD I (r)
0 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 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 receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OFFICIALS S11GAT DATE
DA71rED
RE(O" Ii
`111 'Ta
IN/ER!:,!!( EN (425) ir ib�,6s
0,
�'k 771-0220 REL ED DATE.
eTtNTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 IBC110 If IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
i
0
M
-1 n
M
C 0
M 0
-10
0 C
-4 K
X M
M Z
ID --I
C
Cn
0 -n
n
--I
M rn
00
0 r-
0 M
C (n
9 Cn
M 0
Z
z
Cn
z
0
0
M