20050346.pdf_ DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
54D'P
MAILING ADDRESS
CITY ZIP TELEPHONE
i le
NAME
ADDRESS
I
;1� PERMIT EXPIRES )
PERMIT LO
NUMBERJOBe�'CJ
ADDRESS �� /�L�✓/'"�? L.l./1i
PLAT NAMEISUBDIVISION NO.LOT NO LID NO,
ITLID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required O
Street Use Permit Required 17
EXISTING _ PROPOSED___ Inspection Renuoed O
Sidewalk Required E3
REQUIRED DEDICATION _ FT underground l7
Winno re ueod d
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
1of .. ` YES D NO 0 z
W
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
ul
z
ul
CITY ZIP [TELEPHONE
NAME CBL#
ENGINEERING REVIEWED BY DATE
ADDRESS
E LICENSE NUMBER PIRATION DATE I CHECKED UY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
lC PNPz luZrc� �2 -a (2900� I] YES ONO
3raR,TY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
PROPOSED
❑
NEW
❑
ADDITION
0
REMODEL
FIRE
REVIEWED
BY
DATE
W
❑
CARPORT
CITY
ZIP
TELEPHONE
E LICENSE NUMBER PIRATION DATE I CHECKED UY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
lC PNPz luZrc� �2 -a (2900� I] YES ONO
3raR,TY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
PROPOSED
❑
NEW
❑
ADDITION
0
REMODEL
❑
REPAIR
❑
DEMOLISH
GARAGE
❑
CARPORT
(TYPE OF USE, BUSIN
NUMBER
OF
' ,•� WAIVER 0 ALLOWED PROPOSED . ALLOWED
%. STUDY O
❑ RESIDENTIAL KPLUM611NG MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR O
COMMERCIAL ANCE OR z
MIXED USE ❑ CHANGE OF USE
PARKING LOTAREA PLANNING REVIEWED B 11 Y DATE g
❑ MULTIFAMILY 1:1 SIGN REQ'D PROVIDED
❑GRADING FENCE
CYDS ❑ ( X FT.) REMARKS
❑ TANK ❑ OTHER
❑RETAINING WALL FIRE SPRINKLER
ROCKERY ❑ FIREALARM
NUMBER OF
DWELLING /
TYPE
CONSULTANT
OCCUPANT
GROUP
STORIES UNITS �J LOAD
DESCRIBE WORK TO BED NE REQUIRED DYES
REMARKS
z
<� j
(J GEOTECH REPORT m
r BY:
kr LJ ems, t, L1.J STRUCTURAL DESIGN
r �'? ^ BY:
`'\t��� VALUATION
cjjAAe< el s 1 Di ?lNIR2 $
Description FEE LDescription FEE
�� t' t �J`g�n 3 �UI"r 71111014'1*4M .. Plan Check SurchargeHEAT SOURCE OTSL PEe/ VESTED DATEBuilding PermitSurcharge
PLAN CHECK NO: ?) L„ Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOT D. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION,
r Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS. Fire Review Plan Chk. Deposit
L IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
F 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 L �—
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt, Due �)
D 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 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 Fees 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 COMPENSATION INSURANCE AND RCW 16:27, OFFICIALS SIGNATURE DATE
SWANATURF,fOWN OR GEN DATE SIGNED 0425,
771m0220 RkLEr A�SED BY R AT
ATTENT N EXT. 1333 t
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
j)CRIGINAL . e •YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 I IRC1100 PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD w YOU ARE MAKING 4 COPIES
0
NMIrn
=I �
cM
rn
-1 O
Oc
2M
mZ
JO
DZ
r_ -I
Mn �1
LD1
mm
I v
O CM
r
C � I
is Z n
i 2
l t Z
I �
2
I �
Z
O
n
M