20050380.pdfDATE. RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
fv, k kiNel
ADDRESS
52:7 1 rS0 s if 5
CITY ZIP TELEPHONE
bill•ae
NAME CBL#
>lt:
ADDRESS
CITY ZIP TELEPHONE
7114 l [PERMIT EXPIRES %
PERMIT
NUMBER ;=C ��L ��_j r�•��C��'
JOB SUITE -APT#
ADDRESS ` fir... � ,r �•�
z2 l /
PLAT NAME/SUBDIVISION NO. L NO. LID NO.
LID FEE b
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Regrtieod Q
Street Use Permit Required
EXISTING ^ PROPOSED Inspection Required O
Sidewalk Required Q
Underground Q
REQUIRED DEDICATION _ FT Wallcared Q
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O °z_
R
W
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
W
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
w
LL
STAT LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO
'D COMPLETED EXEMPT
O YES ON
PROP RTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
4' � WAIVER 9 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY O
❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW z`
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
❑ COMMERCIAL COMPLIANCE OR =
13 ADDITION El MIXED USE 1:1CHANGE OF USE z
REMODEL ❑ PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY SIGN REQ'D PROVIDED
❑❑ GRADING ❑ FENCE X. FT.) REMARKS
REPAIR CYDS
❑ DEMOLISH ❑ TANK 1:1OTHER
GARAGE ❑ CARPORT ❑ ROCKENING RY WALL ❑ FIRE ALARM FIRE LER
(TYPE OF USE, BUSIN S OR ACTIVITY) EXPLAIN:
TYPE OFjj;TION7
OCCUPANT �
GROUP
NUMBER NUMBER OF
OF DWELLING SPECIAL PECTION CONSULTANT OCCUPANT
STORIES_ UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED ES
REMARKS ,v y _
a �' o
4 �rLc eK5�5 �w r J o is' j GEOTECH REPORT m
BY:
/
's� ` �Q�+wS C�+�•/1 x(ev ew J STRUCTURAL DESIGN
Q BY:
VALUATION
.�i .� .••t.1.S 1NXISi'IN 6-'rr� $/ 4 .-
Description FEE Description FEE
Plan CheckA 0!;0ler State Surcharge � ./
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit r City Surcharge
PLAN CHECK NO: 00,i Plumbing Base Fee l 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 Gfading.
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
C PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
r
Lu 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 #
WALL 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 lnsp. Total Amt. Due C
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Xi Recording Fee Receipt # ` 9 �
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until signed p the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building receipt
i or acknowledged
Deputy* in and Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledcJed m space provided
WORKMEN'S , SATI tN, ORANGE AND RCW 18:27. 11111111l - I COF IALS SIG TUBE DATE
SI NATO W E R TDATE SIGNED . (425)J11601e�J
5 - 2 771-0220AS D W,1114 _ TE
ION EXT. 1333
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 -IN PEC R
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC110 I IRC110. PINK -OWNER GOLD - ASSESS R
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