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20050364.pdfDATE RECEIVED 11 PERMIT EXPIRES CITY OF EDMONDS PERMIT R �;�, �r-__�i'>' CONSTRUCTION PERMIT APPLICATION JOB ADDRESS / �_ / SUITE/APT" OWNER NAME/NAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO MAIL NG ADDRESS LID FEE $ w r �l ✓�1`��✓ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved ❑ O l 666 ' \- L RW Permit Required ❑ Street Use Permit Required ❑ CITY ZIP TELEPHONE EXISTING PROPOSED _ Inspection Required ❑ SidewalkRequired [3REQUIRED DEDICATION FT Underground /00fZ_ 77 n Wrnequ rod O NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES CI NO 0 LU LU i A15DRESS REMARKS to �// r� /f �x , l OWNE R/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP tfv(/TEL(EPNHONE o ; -77Y —Y701 NAME /1 .. L A t . w .. , i „ CBBL# % Lro� % % " f ENGINEERING V D BY % DATE ADDRESS �1��,. • FIRE REVIEWED BY DATE to F-1 CITY r ZIP TELEPHONF v. - - - ------ - STATE LICENSE NUMBER EXPIRATION DATE CH KED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA REO'D COMPLETED EXEMMP•T Z�A� - 1.3& L00�`ES 0 NO ✓ CA# ZONE SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. _ 2 /) {� WAIVER E3 ALLOWED PRO SED ALLOWED PROPOSED ©.,3 Z t/ D j Z ��7 DD STUDY 13 ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR COMMERCIAL COMPLIANCE ORof (� z ADDITION '❑' MIXED USE ❑ CHANGE OF USE 1 z 1:1 PARKING LOTAREA PLANNING REVIEWED BY DATE 5 ElREMOD[L ❑ MULTIFAMILY SIGN REQ'D PROVIDED T�H J ❑. REPAIR ❑ GRCL ADING CYDS ❑ FENCE X FT.) REMARKS NL 1:1DEMOLISH ElTANK ❑ OTHER ❑ GARAGE RETAINING CARPORT ❑ ROCKERY WALL ❑ FIREAFIRE LARM LER (TYP - OF USE, BUSINESS OR ACTIVITY) EXPLAIN: ff��WLAC i ftl� +W W Ak v� 1111 150? TYPE �j1S UCT ON DE OCCUPANT L -T N 1y1� i/� 1 1 " � cVl• G`--(/ GROUP NUMBER NUMBER OF / OF j DWELLING IJC SPECIAL INSPECTION CONSULTANT ptcupffiT STORIES J UNITS (rjJ LOAD DESCRIBE WORK TO BE DONE REQUIRED 0 YES REMARKS _ GEOTECH REPORT � Iccz STRUCTURAL DESIGN r BY: Z:Dr VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE ' LOT SLOPE% 'T"VESTED DATE _ Building Permit City Surcharge PLAN CHECK NO: i , f� Plumbing 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. r Engr. Review U PERMIT APPLICATION: SEE ECOC 19.00.005(A)(5) PERMIT LIMIT: SEE ECOC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. InSPCC110n n'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY r FROM THE ISSUANCE OF T1415 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 r NOR LIMIT IN ANY WAY T14E CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.• Recording Fee Receipt M ' 1 I HEREBY ACKNOWLEDGE THAT 1 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 porntd until signed by the THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC•Off TION; AND IN DOING T14E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Budding ciaipt i or h nowt Deputy and Furs are paid Lind IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rrcr pt s acutowlrrlguA in space provided WORKMEN'S COMPEN SWNCE AND RCW 18:77. OFFI(:✓LS SIC`iN TUBE DA' E SIONAjUFi ,( NE / DATES NEO (425) ! �1/ l n / 771-0220 RF.FA ED �.i DATEAT ION EXT1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL �' /r A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL • FILE YELLOW INSPEC OR FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 1 IRC110, PINK • OwNEI4 GOLD • ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES 0 '_'1 m Cm mo 0 aml DTI _M mZ 10 C Z r � 0 7n mrn_ 0� r- 0 r Inn --I D Z T I � Z 0 I 0 m