20050249.pdfDATE RECEIVEA-> CY'Zq/
s- a 65 PERMIT EXPIRES ( �
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNAME/NAME OF BUSINESS
LSU A
V/ C. J' / PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
z M IN�DDRESS ���/// / ^ LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Peri d Req d ❑
O 0 / . e RW Pormd Ragwrod ❑
Street Use Parma Required ❑
CITY � ZIP TELEPHONE EXISTING PROPOSED Inspection Regomd ❑
_ SKfawalk Required ❑
REQUIRED DEDICATION FT Underground E3 Winne inquired ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
F — YES [3 NO13 z
UC
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ADDRESS REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE .
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CITY ZIP TELEPHONE
NAME CBL#
JV AA ENGINEERING REVIEWED BY* t l �c ��L ^ DATE
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ATE LICENSE NUMISER EXPIRATION DATE CHRBY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
1 REQ'D COMPLETED EXEMPT
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%6 - -J 7- -• O YES 0 NO
P OPERTY TAX ACCOUNT PARCEL NO. ' CA# ZONE SIGN AREA HEIGHT
a />w �^--) 2 / � /jO��a •�D /\ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
LU STUDY 13
❑ NEW RESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR t7 .
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE
❑REMODEL ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE g
MULTIFAMILY ❑ SIGN REO'D PROVIDED
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREA ARM
a(TYPE OF USE, BUS ESS OR ACT VITY) EXP
' II,Ct PE NS RU TION CODE GROUP
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OF 1 •'r �yt A Q. _ DWELLING ` SPECIAL INSPECTION CONSULTANT OCCUPANT
M'STORIES l �/l.'V��/ UNITS- 1 LOAD
2 REQUIRED OYES -
DESCRIBE WORK TO BE DONE
REMARKS i
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GEOTECH REPORT
BY: Ia
/ STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE �}
Building Permit City Surcharge Q .
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 Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
I= SEPARATE PERMISSION, Engr. RBVIEW
w 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
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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 #
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- CALLng Official or his/her Deputy: and Fees are paid, and
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 wildireceipt i a nowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. O ,FICIA UR DATE
SIGNATU RA DATE SIGNED (425) j3,
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'� .771 71 =0220 RELEASED B DATE
ATTENTIONEXT. 1333
IT IS UNLA�IIIFU OUSE ORO UPY 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 I IRC1104 PINK -OWNER GOLD - ASSESSOR
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