20050410.pdfDATE RECEIVED
r PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ITEIAPT#
ADDRESS SU
OWNER NAME/NAME OF BUSINESS
PLAT NAMEISU BDIVI SION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
uj
z TESCP Approved E3
.41,17 E3
0 Z7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pornid ReQuifod
k 21 72;_'J�4 it'? Street Use Permit Required E3
CITY ZIP TELEPHONE EXISTING __ PROPOSED Inspection Required 13
Sidewalk Required 13
REQUIRED 0 UnCerground 0
)P1 %P Wiring inquired 0
L112 7,7�� 1�4_1 EDICATION FT FIXTURES PRV REQUIRED
NAME METER SIZE L114E SIZE
YES 13 NOO z
'z4 W
'57'11e&4e 71-116421 Al T
W
I- ADDRESS REMARKS z
2: OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
L) 'el P --- E5
19 z
zry"er w
CITY ZIP TELEPHONE
NAME CBL#
Cox r/�/Ot4
V4&. I cnoo ENGINEERING REVIEWED BY DATE
CK ADDRESS
U
9— -1 FIRE REVIEWED BY DATE W
'z CITY ZIP LEPHONE
0 e;14
1414 4125—
STAYE LI EXPIRATION DATE C BY VARIANCE OR CU SHORELINE ORADIIII INSPECTION SEPA
CENSE NUMBER UFCKED REO'D
^e� 1 0 YES 13 N
I CA# ZONE SIGN AREA HEIGH
CX7 111bu( 0j) 01 COIVIPL!:��XEMPT
< 77-PERTY TAX ACCOUNT PARCEL NO' 3 WAIVER 13 ALLOWED P ED ALLOWED I PRO11OSED
a mnwvy)o;� o I
W
_j oo L STUDY E3
LOT COVERAGE R I SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW El RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED ONT SIDE REAR FRONT L/RSIDE REAR
COMMERCIAL COMPLIANCE OR z
ADDITION CHANGE OF USE
PLANNING REVIEWED BY OAT
REMODEL MULTIFAMILY SIGN E
El >
MIXED USE _P_ 5
PA�R LOTAREA E
. �K
REO'D ROVIDI D
GRADING FENCE
REPAIR CYDS x FT.) REMARK -a -
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL o FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: 'UPANT
9: TYPE OF CONSTRUCTION
sup
ILU NUMBER NUMBER OF PANT
OF DWELLING SPECIAL INSPECTION CONSULTANT
UNITS
0 STORIES I —_ FLOOCACDU
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
CAI REMARKS
z
GEOTECH REPORT
BY:
STR MCTURAL DE$IG
4,&�_ Z %1V
B
Aleol &17-" Yiu v 6rj`z;,2!1,fk: VALUATION
$
e:�IAj Description FEE Description FEE
PianCheck State Surcharge
W6C I KI
VESTEDPDAT9
F
I
�A I Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
—7
.5 Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 119,00.005(A)(5)
uj
PERMIT LIMIT. SEE ECDC.19.00.005(A)(6) Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION 111111111
U) S Fire Review Plan Chk. Deposit
w 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
LU IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 NICE Landscapelnsp. Total Amt. Due
j DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
1 9 . Recording Fee Receipt #
1 HEREBY ACKNOW . LEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPE'ICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hisihor Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSAT15KURANCE AND RCW 18:27. OFFICIA S SIGNA E DATE.
BAT
E SIGNED (425)
SIGNATURE (OWNER OR ENT):
"Liz
SED BY
d 771-0220 ATEI
ATT9=MTIr)N EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A 11,1091
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI ORIGINAL FILE - YELLOW /INSPECTC
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 If IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
iP
f
z
0
4
0
M
-i -n
M
C
M 0
0
-40
0
M
M z
C
U)
0 71
n
M.M
a
0
0 M
C U)
r, U)
M 0
Z
X
7-11
M
z
--q
x
U)
z
0
M
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
f
Website: www. dedmondsma-us
DEVELOPMENT SERVICES DEPARTMENT
Planning Building Engineering
April 13, 2005
z
O�
Aldercrest Convalescent
0
M:
ATTN: Facilities Administrator
nd
21400 72 Avenue West
Edmonds, Washington 98026
Q M
M 0
RE: Damage to building from vehicle
0!
0 f'.1
M
ID
Dear Facility Administrator:
Z.
>
ormed me that a vehicle ran into a portion
The City of Edmonds Fire Department has inf
Cn
of your building and caused damage. Thankfully no one was injure d. The purpose of
0 -n
this letter is to inform you that my office. is available to assist you in obtaining a repair
e enclo ed public hando
permit as soon as you are ready to repair the damage (please se S ut
M M
on Fire Repair permits —note, this is the most similar handout we have to assist you).
0 co)�
0 r
or the repair wo&l it is our
The permit fee is based on a licensed contractor's bid f
0 M
CD
understa nding'that some exterior siding, wall studs, and sheetrock may have to be
M 0
z r-,
replaced. If this is not true please immediately inform my office at 425-771-0220
extension 1226. Please be award, if you hire a contractor to perform the work the
company must be state licensed and must also have a city business license.
>
If you have any questions about the permit process please feel free to contact me during
City business hours of 9:00am to noon and 1:00pm to 4:00pm, Monday through Friday.
C&
0
Sincerely,
0
Jeannine L. Graf
Building Official
Incorporated August 11, 1890
Sister City - Hekinan, Japan