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20050252 (2).pdf807)_ r DATE RECEIVED Nell CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS ItW CUP Lae) tY MAILING ADDRESS W ILO CITY ZIP TELEPHON ►7 oto a LejC- .302 . � — �b't) NAME PERMIT EXPIRES l� wool PERMIT7— NUMBERJOB ADDRESS SUITEIAPT# l`l' L PLAT NAMEISUSoIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET 04AP I ESCP Approved 17 RW Permit tim1"'d E3 EXISTING _ PROPOSED Street Use Permd Required 17 Inspection Required o Sidewalk Required 17 REQUIRED DEDICATION FT underground O Weinrequired 0 METER SIZE LINESIZE NO. OF FIXTURES PRV REQUIRED YES13 NO CI z z W REMARKS W OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z z z W NAME .TI v ��j \� �Q VBL# L.j C� b^ (' ENGINEERING REVIEWED BY DATE o ADDRESS U FIRE REVIEWED BY DATE W i CITY ZIP TELEPHONE 5 "bi��©C� LL STATE LICENSE NUMBER EXPIRATION DATE 4E K 8 VARIANCE OR CU SHORELINE ORADB# INSPECTION SEPA YREO'D NO COMPLETED E%EM T ES CA# ZONE SIGN AREA HEIGHT PR/) P RTY TAX ACCOUNT PAR ELN . W / STUDY Q ALLOWED Pf�OPOSED ALLOWED .PROPOSED WAIVER D //V` ❑ NEW ❑ RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR, O COMMERCIAL COMPLIANCE OR z ❑ ADDITION ❑ CHANGE OF USE z ❑ MIXED USE ❑ REMODEL PARKING LOTAREA PLANNING REVIEWED BY DAT g ❑ MULTIFAMILY SIGN REQ'D , 'PROVIDED ❑ REPAIR ❑ GRADING CYDS FENCEIL ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER z ❑GARAGE RETAININGFIRE S CARPORT ❑ ROCKERY WALL ❑ FIREALARM RINKLER n(TY E OF USE, BUSINESS OR ACTIVITY) EXPLAIN: cce /)` 45*ems TY W^ STfUCON C �2 GRCUPA OUP NT I' w NUMBER 7 /N'U'MBER OF lJ �f OF DWELLINGSPECIAL INSPECTION CONSULTANT. OCCUPANT o STORIES UNITS LOAD -� 000 REQUIRED I] YES DESCRIBE WORK Tb BE DONE� c C (J �- CtJ �LL ilk A S/ CI r REMARKS u C�tAl 4) LA6V e GEOTECH REPORT m BY: • y. l eJ, r � � + C.0 I A.� LV Neitf) $4 to Lk tf _y STRUCTURAL DESIGN BY: VALUATION tea. Description FEE Fscription FEE Plan CheckSurcharge HEAT SOURCE LOT SLOPE% VESTED DATEBuilding Permit ty Surcharge PLAN CHECK NO:/ ,, , , � ', Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WOR(Kf 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 SEPARATE PERMISSION, Engr. Review 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 2 *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 N 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 i� = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # 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 Foes 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 receipt is acknowledged In space provided. WORKMEN'S COMPENSA71 NCE AND RCW 18:27, MOFIS SIGNA RE DATE GNATURE(OW ER R GENT): DATE IG (425) �. V - L �- � � ` � � 771-0220 A ED BY � A E ,f n TENTION E. T. 1333 / ' � i c T IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL f -C�1 /1l�,� A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- / ORIGINAL -FILE YELLOW -IN PECT R FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110 � PINK -OWNER GOLD - ASSESSOR 10/04 PRESS HARD - YOU AR MAKII�N� - OPIES r� 0 m —� •Ti ui _ C v M 0 0 =M MZ IC) C Z r � 0 71 mn mm ON 0 r C ca r M0 Z �. X Z Z 0 Z 0 0 M