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20050352.pdfDATE RECEIVED C1 TY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS _ MAILING ADDRESS ZIP I TELEPHONE NAME W �- AGDRESS U Z 0 - ' �1 NAME CBL# r 1 ADDRESS i CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPI ATION DATF C ECKED BY F00 e 0 0 �7�►3�C PROPERTY TAX ACCOUNT PARCEL NO. ❑ NEWRESIDENTIAL ❑ PLUMBING / MECH COMMERCIAL COMPLIANCE OR *ADDITION ❑ CHANGE OF USE �� ❑ MIXED USE ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN ❑ GRAPING FENCE REPAIR ❑ CYDS ❑ ( X FT.) ❑ DEMOLISH ❑ TANK ❑ OTHER ❑GARAGE RETAINING FIRE S CARPORT ❑ ROCKERY WALL ❑ FIREALARMRINKLER (TYPE OF USE, SINES OR ACTIVITY) EXP IN: PERMIT EXPIRES <�;Wo ERMIT Y p NUMBER JOB SUITEW,34# ADDRESS PLAT NAME/SUBDIVISION N .'� LOT NO LID NO, LID FEE 5 PUBLIC RIG T F AY PER OFFI IAL STREET MAP TESCP Approved ❑ RW Permit Requited ❑ . Streol Use Permit Required 13 EXISTING _ _ PROPOSED Inspection Required Sidewalk Requited REQUIRED DEDICATION FT lJnderg(rwnd ❑ �- -- — Warn required [3 METER SIZELINE SIZE NO. OF FIXTURES PRV REQUIRED /� t7 i YES I7 NOD W REMARKS, W OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z O z s0 t Ogg W ENGINEERING REVIEWED QY DATE 411 1 Zed r FIRE REVIEWED BY DATE W s LL VARIANCE OR CU SHORELINE OR ADB# I INSPECTION SEPA RED 'D COMPLETED I EXEMPT T_ i7 YES jXNO CA#�y�(f ZONE SIGN AREA HEIGHT WAIVER.ALLOWED PROPOSED ALLOWED PROPOSED STUDY 13 - 60 1 LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROP05D FRONT SIDE REAR FRONT UR SIDE REA 2 PARKING LOT AREA PLANNING REVIEWED BY DAT1110`R�EQ�'PROVIDED „Q O O ' n [.i I diu.-�_ ARKS 'TYPE OFr fRUCTION E OCCUPANT GROUP ° NUMBER NUMBER OF •.J OF DWELLING ' SPECIAL INSPECTION CONSULTANT OCCUPANT STORIES \ UNITS LOAD REQUIRED YES DESCRIBE WORK TO BE DONE REMARKS '1 GEOTECH REPORT BY: BY: ` ./ VALUATION Rep I •. '� �n�d Description FEE Description FEE Plan Check - State Surcharge v v HEAT SOURCE LOT SLOPE° VESTED DATE Building Permit City SurchargeZ. 19 -PLAN CHECK NO: ©r-- 1 I Plumbing " Base Fee00 r THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, 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. � Engr. Review u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) i PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. InSpeCllOn Fire Review OF Plan Chk. De osit � n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS p G A IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF G� Y EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #(260 = 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 1 ` 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # .) 1 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• CALLBuilding Official or hlslhor Deputy and Foes 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 COMPENSATIO URANCE AND RCW 18:27. F LS SIGNAT E DATE DATE SIGNED (42CCJ) z 1 0 0 �m _. M 0 0C i Mz C z 6'n I MM ON cc Z r— 2 D 4 z 2 Z. 0 0 m SIGNATURE (OWNER OR G NT): I . y �7�% f 771-0220 REE SED BY / DA `/ ATTEN 10 EXT. 1333�" L� IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - .ALE LE •YELLOW -INS EC OR FICATE OF OCCUPANCY HAS BEEN GRANTED* UBC109I IBC110 I IRC1101 PINK -OWNER • GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES eNV i ous Scccc l k p 9 nhA a e IiowN T• QN •y A I K �. r., 6 1 . c A qqo ►, 9,� 0 2 f X� K 4 4� •y W�y 2 SI S'4' 3�p,.9p= Al ,gs.2a /QVarae Adua 411, 10 EXi6 T�'�j �.• �C — � r'—f -� �oi / V /`+ ' �Qa q, 900 ,! ` i ` --• 9L6�. :JAL L_ ° - - - Q9.2 i � 9Q•9d -+- � rn a CL ONO olqN 1 0 v ++ i,; �m n t '� (� a I Q o • rLAi rL pi 16 Kt z z INNONNON OPINION ca �. jj N ADD GUTTERS /DOWNSPOUTS 4yn AND SPLASHBLOCKS o: r kx�s�,k ra:. fous 1601 It 3 P o N y ., *. n rn 410 dj% NNNNoN,,NNN C: ca ko Now 15 ,low". ' millM U��1 • lA !��,•� �. _ NOON NOTED _ i. rr�` w J� \^ 1 /�ilhit..��.I-1.1 'k,, y z 4;Y Z.'NOQ INEERiN (( �� Dl D t Ir, p Z: LTJ Q ✓ r_ ........ (/) J �/ / ......... [)ate:..... _,_..LL? 1 -411111111 m f T NO io Sc ale NONONN P, 0 T 44ooYf.soo.�o3io.a �. K of V �c c( /� q bt Gw �' 7• rtj*" t dC$ F ITV C®PY . 4 i s .. . .' - ,. IIIA �� ■W///�Y r/�YO������1.- ,.��T 917 -134th St, SW, Suite A-1 Ph 425.742.9360 Everett, WA 98204 Fax 425.745.1737 10029 S, Tacoma Way, Suite E-2 Ph 253,584.372.0 Tacoma, WA 98499 Fax 253.584.3707 7911 NE 33rd Drive, Suite 190 Ph 503,281.7515 Portland, OR 97211 Fax 503.281.7579 INSPECTOR: i I t f' HRS: "r { INSPECTOR: i HRS: INSPECTOR: -HRS: TIME: TO: SUMMARY: ( r 1 1 ( ; 1. { f t"�: l i an �.�, _ JL"F V (� t J •,G� l � t.l r'�'ti/'1 iJ !� rJ Jl �. t .J j f i i cl l (-..% M t / m f till M �L . • ! mz 1 .t QD Z c f� �, 1t .°�-' �f" ;,� �: �.��, t. �!,- �� �, f. �,.1 ,- f � � ��� �� , � � c ` ._>; �.�� ; •,sir, x � � tn. 0 �1 ( r wn �. m M WEEP 0 ill i WENSI y z co RCwQ z 0 MAY 2 70 0 N, IT11 DEVELOPMENT SF -RICES 1( CTR• >. ,...; To he,best of our knovJledge iterrls'inspected this'date are to accor.rdance wtth'approved plans and,specrflcattons t Yes No LD Preliminary, Inspection ❑ NONCONFORMING CONDITIONS/CORRECTIVE ACTION TAKEN: .Q i W 'dry "40 .,M %wll, .i , 0 JOB NUMBER '" I '' . DATE: .10"W," ; PROJECT: PERMIT #. %'E .� .. -,, .I ��EATHER: (..e OWN: ARCH: ENG: CONTR: TYPE OF INSPECTION: SAMPLES: SUMMARY: ( r 1 1 ( ; 1. { f t"�: l i an �.�, _ JL"F V (� t J •,G� l � t.l r'�'ti/'1 iJ !� rJ Jl �. t .J j f i i cl l (-..% M t / m f till M �L . • ! mz 1 .t QD Z c f� �, 1t .°�-' �f" ;,� �: �.��, t. �!,- �� �, f. �,.1 ,- f � � ��� �� , � � c ` ._>; �.�� ; •,sir, x � � tn. 0 �1 ( r wn �. m M WEEP 0 ill i WENSI y z co RCwQ z 0 MAY 2 70 0 N, IT11 DEVELOPMENT SF -RICES 1( CTR• >. ,...; To he,best of our knovJledge iterrls'inspected this'date are to accor.rdance wtth'approved plans and,specrflcattons t Yes No LD Preliminary, Inspection ❑ NONCONFORMING CONDITIONS/CORRECTIVE ACTION TAKEN: .Q i W 0m _ s - z Inspection Fees TO BE PAID $ : dCD z Contact notified of fees due: by phone correction notice given n M Date Paid: CJ l Receipt #: Collected By:�, OF �� ❑ Engineering Notified of Payment Received . ••exile A:Y�r/O�i/,'l. aras}r�s!ro'Le�e/r.JYi riorn+9.v.cwiV.arrt..:•r�r..r.:vx9r,.r�ir::.•ar. �:rs...;.r.:rns:n iel �,..•� ...:.K:r.av:v s•.v.:r,:.a o: r.:u:raavr.e/%.c:..•G.•rAsna:n 4+csuLr. xt: - REFUND Due: �- $ . �.:.lar..vn:n•.iii...,e..•�e.•..�is.:va�:r..✓io:irw.rrrscnvv., .vir .i.,...,,:x, ..�u-....,:s...rn..+•ar.«:a•r..a:d.-..:..n..�:r.,....,:,i...,:.nr.,�r,r.:...r.. ..r,w.;:-.�... :.e ..;r,.e. rel- Reconciled By: G Date Original to:. ❑ Perrtiit File Copy to: ❑ Engineering Admin (refunds only) Revised 3/2/06