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20050294 (2).pdfDATE RECEIVED CITY OF EDMONDS PERMIT EXPIRES r r USE EiE PERMIT /} NUMBERC��� V {� CONSTRUCTION PERMIT APPLICATION ADDRESS J SUITE/ OWNEB NAME/NAME OF 13USINESS I T SLG�r�`y`ra� PLAT NAME/SUBDIVISION N0. XECIT NO. LID NO. w MAILING ADDRESS LID FEE $ I O S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP iESCP Approved Q S (-0'�6 o.< RW Permit Required Strout Ilse Permit Req'd CITY ZIP TELEPHONE EXISTING PROP ED Inspection Required (�Q Sidewalk Required REQUIRED DEDICATION! FT Underground Wiring required 13 NAME � % METER SIZE LINE SIZENO. OF FIXTURES PRV REQUIRED YES ❑ NO E3ccZ' �u w C ADDRESS REMARKS zl OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP TELEPHONE I 1 r,7 1^VA�C)0C.�`7yS-�Z.33 s U 2 NAMW % CBLp 1 �/ ENGINEERINGrfMV EWED BY l' DAIE M ADDRESS 3 I 1 ZW aC �- FIRE REVIEWED BY DATE w� CITY ZIP TELEPHONE VARIANCE OR Cu SHORELINE OR ADB# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY RSQ POSTED _.— - ❑YES NO g SEPA REVIEW SIGN AREA HEIGHT a PROPERTY TAX ACCOUNT PA o CEL NO. COMPLETE EXE PT ALLOWED PROPOSED ALLOWED PROPOSED 0 V 43L12aq?0g2, , ` EXP ❑ NEW RESIDENTIAL PLUMBING/MECH COT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FL) ALLOWED PROPOSED COMPLIANCE OR -} G�� © C, Mw N S � W C(�J z ADDITION ❑ COMMERCIAL' ❑ dj/p `(�� r r'• z CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY D(�T� g REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED r "►" `////�� ❑ G ��r FENCE REPAIR CYDS �I ( X Z�� FT) A OTHER (� , c� rt ->0[— %C —C . N ❑ DEMOLISH ❑ TANK ❑ GARAGE RETAINING WALL FIRE SPRINKLER N4• - ,L • I �� �_ _ CARPORT ❑ ROCKERY ❑ FIRE ALARM Q ✓ } . ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: _ L O I s_� fL7 C C1� (� 1^ CHECKED BY TYPE j3STRUCTION Cj OCCUPANT, pbul LvW GROUP 1✓ NUMBER NUMBER Oft RITICAL q ✓✓ m OF DWELLING AREAS U�,, (�4 SPECIAL INSPECTION JAREA `�C& l)�-- /„ L%� OCCUPANT p STORIES UNITS NUMBER �/ REQUIRED ❑YES '��L}I^LOAD DESCRIBE WORK TO BE NE REMARKS S z e.PROGRESS INSPECTIONS PER UBC 108IIBC109/IRC109FINALINSPECTIONREOV allC7in 46 66 IM:t V ` •„�. a %PION ,. VALUATION C�Lle LL 4jp � 6JOVNCOCA Description FEE Description FEE y�QW �,, �j' /� L p:4,, Plan Check , , %✓ State Surcharge i HEATS URCE GLAZING % LOT SLOP % FA ©� Building Permit City Surcharge11:tJl" PLAN CHECK NO:VESTED DATE Plumbing 1- Base Fee Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC G /- DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION, Engr, Review Lu PERMIT APPLICATION: 180 DAYS °L PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk.Deposit � [Jr 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 a f iit� ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS.PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE S LandSCap@ Insp. TOIBI Amt, Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE cJ f r� = 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 1 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 Building Official or his/her Deputy: and Foes aro paid, and IN LVIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recolpt is acknowledged In space provided. WO KMEN'S COMPENSATI INSURANCE AND RCW 18.27. SIG TUBE (OWNER R G NT) DATE SIGNED (425) I�If�C�ALSSIG�TURE �DATE2W0 771=02)20__ � % 1'�v I ASED BY 1 pt DATE ION EXT 1333 IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL A.,L INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU- ECTOR PANCY HAS BEEN GRANTED. UBC 109 / IBC110 / IRC110. QR K - O - N YELLOW - I S -ASSESSOR NK -OWNS GOLD -ASSESSOR 09/03 PRESS HARD =YOU ARE MAKING 4 COPIES Z 0 n M NMI!wn CO) "I cM M0 -i O O awl0 _ C mz Q � CZ �C0 0.071 Wirt mm_ ON C 0 C n Zr z N O n M S4 CGa wC t rn �^eyJ*' Re W S op�I e l o+ P l o KA 7 i�o rstl,� —+vCf �N t l l � TOSS r ro. v�' - �i EAOAOrJS„ uAA �^�y11 dN�S WA t�Z� H2c ' I • 6,(2 r� . `� "7 i • o l I �w�a��As BIGc 0y3 p -o2, 5(4, eN a3 S"(o --=-- {' fill 1u.5 AAO 5 .t 12 Uo G APPROVED AS NOTED tY c:NGINEERINGtocukl",it der{ 'Io be 4 2.gkrS. z !. fill �,.1..�� ...� �.4�? �ZadS��q, �9s•84 /I,00 I U'xl MI I IT sipQ tree^' t.)1V� r.1/�C,. i >!i ,- , .. , : l,., f R U[V��I,.il. �1- S- i J f, I1ti�l0Ioli Air 06.,, - �COPot�� InwaST �va•,.� G�®4 f Ma 1 C +91.66! Qltoa•�r`+•. -(-9S' � 1�i1 If LZ i NMI L +10 L 9l .nth C 00 wilt rV000 4111111111 of ��\ Ad,d,�;�4 hldt,#etivti �co�os�c� �k ke `.' "' 4 � on '441 L it L f m M If It `roQ s��t. 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ANI1 Ii`�SPI"CTION F E00IRcf.) �21�I, I o f i ccv�tcr of r igh+���I � CITY COnx7 ��aq �� Y Inspection Fees TO BE PAID $ Contact notified of fees due:: ❑ by phone. .�] correction notice given Date Paid: 1�� �' Receipt Collected By: 1 Engineering Notified of Payment Received . ZlAaj A �jt+ • '. � ,.. ''Cl'lm.A;.C.R,yf.ir'lf;ren/rtl:Ie,1'�:w'icr.r,:n:1,,n Jc..:9Seq-s,..:...:v..e.v�P,:....ee._.J.a...-L..+::O:.r:•n..:..,.�.'.:r;i1L-....J..."..s;_t.raSA.:J..,arC.>ru x.-.. �.L,v .Y.f REFUND Due: Y . �'x:a,n-iY �iJ.'O.QLN::rYir•a.J:Y. iM LCCN�.K'.Y;:f-.YY'�...�':+..�r:�...."'a'wn N.:n.:R.L.,; :Y,.... /.:.f i. '1')..,r]...,W';C.J<L:h::..�:C:.N.6A¢t'.+>Sw.u'..t a. a: �l-Y. e::fvl.v:.f..J.��.. ReconciledBy. Date rG ' t v Original to* Permit File Copy to: ❑ Engineering Admin (refunds only) Revised 3/2/06 IT IN I IN NI I I t it Not IT I IT IT I. I` FINAL PROJECT APP.R.OVAL~OR107 ' ' t) t To t' I P' 1. ` asIN TO III TO �:, y• l t r �,fr)pl I did " l 11OITT IT I ; r _ `'i < i l , I Id + �'I IN I(r tit `rt y j Iad IN nIT I•rEIN IN To. I IT �r <r IT TO i r + Y It IT `MEMQ TO ,PERMIT COORNO DINATOR; BUILDING'DMSION di IN I i FROM _ FIRE DEPARI'MLNT DA'I'IT I ;Y x; IN I 4� , •. i1 ^I +I NO IT r : -TIT1 '•' ,PLEASE SIGN 1 Ia I 1 �:" I IT IT IT IN 61 ` ENGINEERING DIV [BION `IaA1'E . , �, Nd did. ANT, �- r b. a r> / t � PIF JIrA i. IN NNINT I t _. � Aa -), •: t tIN r - � f,� t `vs"i to IT I ITT IN, J 1 <f\ o I IN)TIT ` t V d. I'r f ': �•. , _ li ;Mr r , 1 I' _ \ 1f1 f p i I.>t I INIT �t 1( PLNNTiNTIT G nIVISION DATE 1 i. r' IT IT r 7,; 11't ,1"did Y t PLEASE SIGN i.) r , -'t - 1 1 r ;' �' 1 . 1 t 1 ', r j r 1 ;IN I IT IN If I I TI PROJECT . r, �YFrY. i �N(! ��I�I////�'''���� II 1 t 1 1 .n. 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