20050351.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS NUM IT
CONSTRUCTION PERMIT APPLICATION JOB su1TEtAPTa
ADDRESS
OWNER FJAMEINAME OF BUSINESS �
PLAT NAME/SUBDIVISION N0, LOT NO LID NO
M MAILING ADDRESS LID FEE S
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O 10 t', IESCP Approved - E3�� ��i PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required ❑
Street Use Permit Required ❑
CITY ZIP TELEPHONE EXISTING _ PROPOSED Inspection Required 11Sdewalk Roigmred C3S C041LO, B s aob 3sg Ob 69 REQUIRED DEDICATION FT _ Wludergrround d
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NAME �t1 (� , ` METER SIZE LINE SIZE ]77XTURES PRV REQUIRED
4 1"7', �!i YES 0 NO CI ?
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I= ADDRESS REMARKS w
U OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE z
� b a 4 �4 �� s� `- 300 z
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CITY ZIP TELEPHONE
s�q 9 B 161 90 6� 6E a 106%4 -
NAME
�svls/ ENGINEERING REVIEWED SY DATE
ADDRESS
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Z CITY ZIP TELEPHONEL i I LL
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VA ANCE OR S RELINE OR ADB# INSPECi�TION SEPA
STATE LICENSE NUMBER
QTEXP�IR"ATIO DTE OBY REO'D COMPLETED EXEMPT
W�� L]`�► {�IJU V 7 OYES NO
-J PROPERTY TAX//ACC NT PARCE NO. CA#, ZONE SIGN AREA HEIGHT
C ') ••\ '�-WAIVERD ALLOWED PROPOSED ALLOWED PROPOSED
�STUDY D
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIALCOMPLIANCE OR
❑ ADDITION ❑
El MIXED USE CHANGE OF USE y
PARKING LOTAREA PLANNING REVIEWED BY DATE S
® REMODEL ❑ MULTIFAMILY ElSIGN REQ'D PROVIDED
El❑GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
❑ DEMOLISH ❑ TANK 1:1OTHER
Z ❑ CGARAGE ARPORT ❑ ROCKERFIRE Y 1/1 � ERY WALL 1:1 FIREALARM
LER � �� k. �•`/'N��
a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
L••1 '81rq NC� TYP CONSTRUCTION CODE GROUP OCCUPANT
w NUMBER n NUMBER OF
G OF . Y�V y DWELLING) _
p STORIES ��. V'— SPECIAL INSPECTION CONSULTANT OCCUPANT
UNITS LOAD
DESCRIBE ORK TO BE DONE REQUIRED YES
OY1� VL�kb"k- O�% X41yDX100 LAb ^LO j� REMARKS z
B V Irl WAi1 S YL Ytr✓.S�VOOYYI V� ) GEOTECH REPORT
BY: m
L 'rNOYN ^ LO ,L v l I STRUCTURAL DESIGN
55 BY:
Sf✓`M�G1 D11 r�"�' m VALUATION
1V40 -� AA04" . „o $ G� IGl
Description FEE Description FEE
i f l Z — Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
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Q\01 I I Building PermitAll 7 City Surcharge
PLAN CHECK NO; j ' V �? i Plumbingr� Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO I�^
!_ BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
� . Engr. Review
W
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECOC 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 INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLO HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #C-
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 AmL Due -w
= 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• This application Is not a Deputy:
until signed p the
TION; A GING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official i a knDWr dgedi and a pr are pard, and
IN VI ATION a� THE'LAB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged m space provided.
OR EN'S COMPENSA RANCE AND RCW 18:27.
FFIC WNAt�o DAT
ATUR ( jitGEE��Nl�'i,DATE SIGNED ��)) (425) / e•%
` 6• 771 -0220 RELEASE BY �� A�
ATTENTION EXT. 1333 /�`/� rte_-� • *r
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL t•
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- oRl INA -FILE YELL SPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC1104 PINK • OWNER • GOLD • A SESSOR
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