20050407.pdfr DATE RECEIVED .�
PERMIT EXPIRES
CITY OF EDMONDS ZONE NUMBER a0,) 0g07
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTN
ADDRESS O� r -r --
OWNER NAME/NAME OF BUSINESS
3 A /u K o/>h i`,� M O^ PLAT NAME/SUBDIVISION
�NO. LOT N0. LID NO.
MAILING ADDRESS ' 1 5 ( ID' � � `� 3 / LID FEE $
�� / A' S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
Rw Permit Rngwred p
Y / _7 Street Use Permit Roq'd a
CITY ZIP T LEPHONE EXISTING PROPOSED Inspection Required p
Sidewalk Required 13
ed M c,,Icv s q Sda� �- al��, 3 - S2�j REQUIRED DEDICATION Fr Undoiground
Wiring required Q
NAME METER SIZE I LINE SIZE NO. OF FIXTURES I PRV REQUIRED I .
YES ❑ NO ❑ Z
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CITY ZIPITELEPH ladii0rips I
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NAME
ENGINEERINGFe
ADDRESS Y oir L vent connector3"quire assinSWFIRE REVIEW 'jCITY ZIP TELEPHONE gh unheated spaces. � 803@2 w�
S eG`�i� e `l� 10 � taob) � tag
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STATE LICENSE NUMBER p EXPIRATION DATE CH BY VARIANCE OR CU SHORELINE OR ADEN INSPECTION BOND
M At�Ca �5 `Il! ek�/' OYES 0W0 5 POSTED
I� 30 °b ME I SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
C0 L}3Lty !? 11000 Soo V WA NG
EXP
❑ NEW ❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (F1:)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMPLIANCE OR
❑ ADDITION COMMERCIAL ❑ CHANGE OF USE N �' NL N� i
PARKING LOT AREA PLANNING REVIEWED BY DATE og
REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
FENCE NG �/ 31f
❑ REPAIR ❑ GRADING CYDS ❑
OTHER X FT) REMARKS
❑ DEMOLISH ❑ TANK ❑
❑GARAGE FIRE
CARPORT ❑ R CKIERY NING WALL ❑ FIRE ALARM SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
(Sot 1 _ N K CHECKED BY TYPE OF. CONSTRUCTION CODE OCCUPANT
GROUP
NUMBER NUMBER OF CRITICAL •�"i-a- r7_
OF I DWELLING((�� AREAS �l SPECIAL INSPECTION JAREA OCCUPAN
STORIES UNITS Ir NUMBER / PC REQUIRED LOAD
YES
DESCRIBE WORK TO BE DONE
REMARKS Z
A + �, PROGRESS INSPECTIONS PER UBC 108/I8C109/IRC109 FlNALINSPECTION REO'D 9
m
rh o f
i �o, VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN.CHECK NO: A VESTED DATE`1 %Y
_1lJl Plumbing Base Fee vC.�
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I_ BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
i Engr. Review
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
S DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp, Total Amt. Due C
x NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt M 31
t
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- CALL This application Is not a Permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy' and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COM PENSATIO URANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
ATURE (OWNER OR n DATE SIGNED (425)�o4C u I�
,{. `! •� /
~ / T1 =0220 REASED BY DAT
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL CO �/ � �b .J
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK
- YELLOW. INSPECTOR
-OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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