20050329.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS IV
1006 �.P�
A /Tq�,
MAILING ADDRESS _A14
ADDRESS
Mt 1MR711
ZIP TELEPHONE
9 9,L
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TELEPHONE
PERMIT EXPIRES
PERMIT Zcm 0
NUMBER
JOB 47114
ADDRESS
SUITE/APT#
PLAT NAME/SU BDIVI SION NO.
LOT NO.
I
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
[3
13
Street use Permit Required
13
E3
EXISTING — PROPOSED
irrspection Requited
E3
Sidewalk Required
13
REQUIRED DEDICATION FT
underground
Winnit required
[3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESM NO13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
NAME CBL# 971%j�" I .'" , . �_ - - -
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STN EXPI TION ATE C REQ'D COMPLET
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PROPERTY TAX ACCOUNT PARCEL NO.
WAIVER 13 ALLOWED PROPOSED ALLOWED I PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRS�IDE REAR
COMMERCIAL COMPLIANCE OR z
ADDITION MIXED USE El CHANGE OF USE I 1 2
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY 1-1 SIGN REO'D PROVIDED
GRADING FENCE
REPAIR CYOS 13 ( X FT.) REMARKS
OTHER
DEMOLISH TANK 1:1
[3 GARAGE Ea RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY 1:1 FIREALARM
(TYPE OF USE, BUSINESS OR ACTI IN.
TYPE OF C N 0 OCCUPANT
�TR
L I -A& J Al 6- GROUP
rZi NUMBER NUMEItR OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPAN
LOAD
0 STORIES UNITS REQUIRED 13YES
DES RI W 0 71ON _t
t, REMARKS
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BY:
VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% ESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
in
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
S EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
'W ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR!NDIRECTILY 75
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.6
Rocording 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- 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
WORIKME�>�MPIENSATrll`15TNCE AND RCW 18:27. OFFICIAL SIGATURE D TE
0: DATE VIGNED j (425) C'.
DATE(
771-0220 RELEASED BY
EXT. 1333
ATTENTION
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 - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110- PINK - OWNER GOLD -ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROM 7 APPROVALTORM
TO:
-DATE:
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MEMO TO: PEat 'TOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE__L/L1 r
PLEASESI It,
—ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE_
MEASE SIGN
PROJECT,
SITE ADDRESS /0 914A- '4v- /t/'
PERMIT # ADB# ____.�DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED C/ ir T— '015c4mc... S-0 0-wWr
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that,
there are no objections from the above signed Department to the granting of
4 L)—Final approval of the described work
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—Performance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
4ILGRANT FINAL PROJECT APPRO V*AL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
—RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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