20050221 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS _
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CITY IP IrELEPHONE
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ADDRESS
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PERMIT EXPIRES
PERMIT rJ '
NUMBER
JOB SUITE/APTn
ADDRESS
o6,k e'e I ' 74 6J6.
PLAT NAME/SUBDIVISION NO. LOlNO. LID NO
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP tESCPApVoved O
RW Permit Regwrnd 0
Street Use Permit Required 0
EXISTING PROPOSED _ _ Inspection Required O
Sidewalk Required 0
REQUIRED DEDICATION....FT Underground O
Wiring required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO O r,
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REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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NAME CB
w 69M C A& ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE ,y,
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STATE LICENSE NUMBER EXPIR TION ATE Bl' VARIANCE OR CU SHORELINE OR ADBq INSPECTION I
. �REO 'D COMPLETED ED EXEMPT
�2l�Y I] YES �0 ✓
f, L 0 CAq _ ZONE SIGN AREA HEIGHT
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PROPERTY TAX ACCO NT PARCEL NO. rV
•�•./ WAIVER 1t�. ALLOWED PROPOSED ALLOWED PROPOSED
W IOU ny)1 STUDY O •� 1JG
❑ NEW ❑ RESIDENTIAL PLUMBING/ MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑tU� Nfi ` z
CHANGE
MIXED USE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADING FENCE
REPAIR '
❑ El ❑ ( X FT.) REMARKS
OTHER II "A ;)-,t t1`. fY Off^ e✓ �
❑ DEMOLISH El TANK ❑
z ❑GARAGE RETAINING WALL FIRE SPRINKLER L
CARPORT ❑ ROCKERY ❑ FIRE ALARM
a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
,r TYP OF STRUCTION GROUP NT
U Il
w NUMBER NUMBER OF
O OF DWELLING /j� _ SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES Ur+C LOAD
NITS
-s REQUIRED D YES,.
DESCRIBE WORK TO dE DONE
REMARKS z
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L GEOTECH REPORT O
BY: m
Solo w JIM*, STRUCTURAL DESIGN
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11 �, A Ce L VALUATION
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$ to
Q. Description FEE Description FEE
OL,+ Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge J
PLAN CHECK NO: ,7 Plumbing �0 '� Base. Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical t
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Lu PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
f 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 r-!
G DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt, Due
iNOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'S
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 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
F THE LA ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
MPENSA7 I S NCE AND RCW 16:27. OFFICIALS SIGNATURE DA E
J2ATTENTION
WNER O G DATE SIGNED (42S), - 220 n U� '`5 U,J771 O REL SED BY D E
EXT. 1333 0 Aix,
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 -IN ECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 / IRC110, PINK -OWNER • GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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