20050391.pdfDATE RECEIVED I '
PERMIT EXPIRES
IT
CITY OF EDMONDS NUMBER 12- ,�?
FIAAILINGADDRESS
STRUCTION PERMIT APPLICATION ADDRESS JOB SUITEIAPT#
EINAME OF BUSINESS `y l
(,` \ `IQ; PLAT NAMEiSUBDIVISION NO. LOT NO LID NO.
} ',{- C
LID FEE 5
TESCP Approved OPUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required OStreet Use Permit Requited ❑ ZIP TELEPHONE EXISTING _ PROPOSED lnspociion Required I7Sidewalk Required 0underground✓Hl�oREQUIRED DEDICATION FT Wmn rc uited ONAMEMETERMETER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
0
r. q
YES 13 NOD z
P/' L L w
I=ADDRESS REMARKS _
cziOWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
z
a 196 2y 7 /0 V6 cx�/ w
CITY ZIP / TELEP7HONE -y
ii.,loo e,4 574
NAME CBL#
I 9 ENGINEERING REVIEWED BY DATE
W. ADDRESS q
t_ ,/Z
/J ^
!i 0' E / �!� FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE
LIICENSE NUMBER EXPI ATION DATE CKE BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATES L
/� Q—� q , // REQ'D COMPLETED EXEMPT
All P 14) J. /G% G /` � l.O �C� �� iAREA ONO
CA# ZONE SIGN AREA HEIGHT
-r PROPERTY TAX ACCOUNT PARCEL NO.
Q WAIVERi] ALLOWED PROPOSED ALLOWED PROPOSED-
STUDY i]
❑ / MECH RESIDENTIAL PLUMBING LOT COVERAGE' REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑
NEW RESIDENTIAL PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIAL COMPLIANCE OR .
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE PARKING LOTAREJ PLANNING REVIEWED BY DATE g
2rREMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ REPAIR ❑ GRADING CYDF [3 FENCE X FT.)REMARKS
❑ DEMOLISH ❑ TANK ElOTHER
GARAGE RETAINING FIRE S
z. ❑ CARPORT ElROCKERY WALL❑ FIRE ALARM RINKLER
I a (TYPE OF USE, BU NESP OR ACTIVITY) XPLAIN:
F,CONSTRU .TION C, r E OCCUP
ti ' GROU
ww NUMBER P
NUMBER OF
OF DWELLING/� / SPECIAL IN P CTION CONSULTANT OC PANT
W UNITS li LOAD -�ez 09
p STORIES REQUIRED L7 YES.
DESCRIBE WORK TO BE DONE
REMARKS
z
rl Ir. GEOTECH REPORT m
f � BY:
4/. fl'� W.�' STRUCTURAL DESIGN
BY:
ter C• --� k�t1 s i) 1 Lq � C0 VALUATION
gA,��. ��,, $
04 Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK N �.- _ Plumbing Base Fee
HIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
i DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
C SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a.. PERMIT LIMIT: SEE ECDC 19.00.005(A)(0) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
DEEMED TO MODIFYt WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
= 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 nota permit until signed by Ilia
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hislher Deputy: and Feos are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, OFFICIALS SIGNATURE l DATE
SIGNATU (0 N AGENT): DATE SIG�NJED (425) M +�l
AG/ `-' 771-0220 RELEASED/BY _J_✓JJ DATE
ATTEN ON EXT.. 1333 k
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTILW'kl
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINA _-FI E • YELLOW -INS [CTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 1 IBC110 1 IRC110, PINK • D ER • GOLD • ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
0
r
m
N NMI
cm
my
0
On
_ M
mZ
p
Z
CD
r=
07n
M lm
O0
r -
C �
a mn
Z I
_.
D
t �
W
Z
O
41111411m
i