20050255.pdfGATE RECEIVED
PERMIT EXPIRESSE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS f �)j f de 64 7
OWNFR NAME/NAME OF BUSINESS r 1 l
Cl PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
VfA
cMA INit' ADDRESS LID FEES Q
C ' TESCP Approved
p �� /r �� Lr PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
�./ l 4 Street Use Permit Roq'd
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required p
Sidewalk Required 13
_ ( i r [• " Underground
G`mUhC�` wD •�1& � �1t� REQUIRED DEDICATION FTWiringrequired 0
NAME ` 1 ' METER SIZE LINE SIZENO. OF FIXTURES PRV REQUIRED
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ADDRESS REMAF
OWNE V&fm"mr>Z�gER•XMrCM m8NRAINAGE
a CITY ZIP ITELEPHONE through unheated spaces. IMC 803.2
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ZIP
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FIRE REVIEWED BY AFFIDAVITS SHALL NOT DATE
STATE LICENSE NUMBER EX CHECKED BY VARIANCE OR CU SHORELINE OR ADB# . INSPECTION BOND
REO'D POSTED
�� 7L—L •L7' lJ, �t �"i ❑YES ❑NO g
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PAR EL NO. j COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
J� EXP
❑ NEW RESIDENTIAL ❑ PLUMBING ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWE iAG1IT EBOGIT. .LJBADE REAR =
COMPLIANCE pp,,�{.�yy �4
❑ADDITION COMMERCIAL OlJI.G bri +.legj 1 i
❑ ❑ CHANGE OF USE
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❑ LLc gQgL
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MULTIFAMILY SIGN REO'Ds
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GRADING FENCE ••
❑ REPAIR ❑ CYDS ❑ ( X FT) REMARKS I
❑ DEMOLISH ❑ TANK . ❑ OTHER
SPRI
❑GARAGE RETAINING❑ ROCKERY WALL FIRE ❑ FIRE ALARM LER
CARPORT
USE, �USINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CyOfcl$+'jRUCTIO CODE . OCCUPANT
1 119.
GROUP12
ui NU BER NUMBER OF CRITICAL
o OF L DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
Ot STORIES ✓ UNITS I NUMBER REQUIREDLOAD
❑ YES
ESCRIBE WORK TO BE DOE
REMARKS i
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D 9
cxt VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge �J
PIAN CHECK NO: VESTED DATEAiRg��
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Mechanical r'
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC Gradin
1 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION.
Engr. Review
w PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U3 •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit
9 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Q 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
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT Or ANY CITY ORDINANCE Landscape Insp, Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•E
Recording Fee Receipt # 4L1
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ 1HIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED This
Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 1827.
10 ICIALS'MNAIURE DATE
OR:nGENn r DATE SIGNED _ (4L5) _ •"
SIG ATU/IRE (OWNER \1f✓ Z
cl, _, 771=0220RELEASED Y DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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