20050409.pdfDATE RECEIVED
PERMIT EXPIRES
' PERMIT '
CITY OF EDMONDS NUMBER �) `r(. 'L
CONSTRUCTION PERMIT APPLICATION ooREss SUITErAPTu
OWNER NAMEINAME OF BUSINESS Lo?Leo �') �s rj �>
S' P F 4S5 C e- r` 7T p> LL PAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE 5
2r> /� l PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAPTESCP Approved
RW Permit Required ❑
Sheet Use Perrn,l Required ❑
CITY ZIP TELEPHONE EXISTING _ PROPOSED Inspection Required ❑
Sxlewalk Required ❑
— llntlergmuntl ❑
REQUIRED DEDICATION FT__ Mind required ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO O z
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ADDRESS REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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TELEPHONE
NAME / I CEu ti t
EIewe o �'-r�� Nit/tj �hC ENGINEERING REVIEWED BY DATE
ADDRE 5
72 s. .��� o,t W5;1
FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE x
Ile 7T/ cep
STATE LICENSE NUMBER • EXPIRATION D TE C By VARIANCE OR CU SHORELINE OR ADBt< INSPECTION SEPA
REQ'D COMPLETED EX'h1 T
/ i7O ,•P 7 % �G // �— -CSX-) � YES 13N
0
7NO F
C L �/ / W CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO:
O a �� Po O O /SO � WAIVERE3 �/� _ ALLOWED PROPOSED ALLOWED PROPOSED
STUDY if/ 3Jr
❑ NEW ❑ RESIDENTIALMBING ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIALC PLIANCE OR Y
❑ ADDITION ❑ CHANGE OF USE
❑ MIXED USE PARKING LO'rAREA MNING EVIEWED BY DATE �j a
�/IFEMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ REPAIR 1:1 GRADING CYDS ❑ FENCE X FT.) REMARKS
❑ DEMOLISH❑ TANKGARAGE RETAINING FIRE
❑ OTHER
❑ CARPORT 13ROCKERY WALL ❑ FIREA ARM SPRINKLER
U (TYPE OF USE, BUSINESS OR ACTIIVY) XPAIN:
(`}J� TYP CONSTRUr COONT
D GROUP
W NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES / UNITS f"C _ LOAD .
7 REQUIRED I3 YES
DESCRIBE WORK TO BE DONE
/ REMARKS
In Sf `Y �� s ^A� GEOTECH REPORT
/ / J BY: �/ �/
G �a't/lrr C Cbo 7 N N / T S / fj e4' `j&V w X/ STRtlCTtlR11L DESIGN � /` // f✓Aj /1 Ar
11 BY: , ` G�(r/C /7
5 f VALUATION.
�✓"�,lH.�� /�- �- �S gym- $
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOUR9E LOT SLOPE (oVESTED DATE
Z� EIe� _/ % e� NN Building Permit City Surcharge
PLAN C14ECK NO: �-� —� Plumbing ` Base Fee
/ Mechanical r
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION, Engr. REIVIBW
Ix W
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION �Ilgf. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Ui 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 #
a 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
C NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt# �L
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 not a pormlt until signed by the
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or knowl dgediDeputy: and Foes aro pard, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSAT ANCE AND RC W 1B: OFFICIALS SIGNATURE DATE
SIG NA OR DATESIGNED (425)
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5>.w 771 0220 RELEnu
ASE BY DTE
TTENTION EXT. 1333
IT UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL "✓
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGI AL E YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 1 IRC110, PIN ER GOLD • ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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