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DATE RECEIVED
C 'r PERMIT EXPIRES
i'PCITY OF EDMONDS
NUMBER �`-
CONSTRUCTION PERMIT APPLICATION AD �. ITEIAPTNj
ADDRESS > y �-)
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OWNER NAMEINAME OF BUSINESS Z!-�
GG,� ` ,► A� _ v PLAT NAMEISUBDIVISION N0, LOT NO. LID NO.
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MAILING ADDRESS / LID FEE S
Z �r r PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved! ❑
0O e ` V �( %i (/� - RW Permit Required ❑
CITY ZIP TELEPHONE �`r �!C%V 1 _
Street Use Permit Required ❑
EXISTING _ PROPOSED Inspection Required ❑
_ Sidewalk Retuned ❑
• - undergrwnd ❑
Z _4 —Y'V 5 REQUIRED DEDICATION FT _
` Wiring required ❑
NAME METER SIZ=E SIZE NO. OF FIXTURES PRV REQUIRED
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F YES O NO 13 Z
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LU
ADDRESS REMARKS _
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY 71P TELEPHONE
NAME `C/fi7 CBL
ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY GATE w
CITY ZIP TELEPHONE LL
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STATE LICENSE NUMBER EXPIRATION DATE C ECKE BY VARIANCE OR CU SHORELINE OR ADBN INSPECTION SEPA
REO'D COMPLETED EXEMPT
Z OYES 13 NO
CAN ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. L
WAIVER E3 ALLOWED PROPOSED ALLOWED PROPOSED
0 %1 ( � /7V. ._O h ( .r STUDY 13
❑ NEW ❑/ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
�,/ ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
{.ii COMMERCIAL COMPLIANCE OR
1:1ADDITION ice' ❑ CHANGE OF USE Z
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE 5
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
GRADINGFENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER A ^ l
❑GARAGE RETAINING WALLFIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREALARM///� 0 G/D
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: �J l/�
TYP M T U 10 C E OCCUPANT
GROUP
NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT'
STORIES UNITS LOAD
REQUIRED E3 YES
DESCRIBE WORK TO BE DONE '
CP 4IL99 /2Cf'4Aca:�v cr✓"� REMARKS i
C /f�0 ✓��% / t L�Ci�Ceo V4. A/c ( GEOTECH REPORT
BY: Im
S zi;�-T1 p vL �fa L C. L G�%f� lS STRUCTURAL DESIGN
BY:
• S �' G! - V - VALUATION
LA r1 $42 .
_ L Description FEE Description FEE
• �,5/^/�J /g6q�/��,•/�'(�h P*40W4*v/ Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit 3 � . City Surcharge k
PLAN CHECK NO: Plumbing �Z� Z 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
f DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
s Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HE ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
.j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
Q 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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee _ Receipt #t 14
1 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 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 receipt Is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION SURANCE AND RCW 18:27, OFFICIALS SIGNATURE 1 DAT
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DAT7'�
NED
x SIGNATU AGENT): .(425 ) �y l J
\ e� %�l L� f Z r/' 771 -0220 R - SE DATE
ATTENTION EXT. 1.333
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 • YELL w -IN ACTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 1 IBC1101 IRC110. PINK -OWNER •GOLD •ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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