20050414.pdfDATE RECEIVED PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER 6V
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
OWNER NAME/NAME OF BUSINESS t.ADDRESS
'T P
), ) I i j - I PLAT NAMEISUBDIVISIO147NO LOT NO, LID NO.
1 11, F"
MAILING ADDRESS
?,i q o ai 9 Nutt- LJ
CITY ZIP TELEPHONE
-7
22111uyx�j- IL
NAME
ADDRESS
CITY ZIP TELEPHONE
NAME CB1_4
q
Ij yk 4 74
. IA UIR I Laj
ADDRESS
TELEPHONE
STATE LICENSE NUMBER
I IRITION
DATE
fr*�W
t.,j(eSqe�
j og
PROPERTY TAX ACCOUNT PARCEL NO.
003-73
13
It
7
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
El
SIGN
REPAIR
GRADING
CYDS
FENCE
( x
E] DEMOLISH
TANK
OTHER
GARAGE
o
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
PUBLIC RIGI IT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE j
� In additio4 to the
REMARKS
OWNERJCI
F
LID FEE S
TESCPApproved
RW Pernia Rrr.tuirod
Street Use Permit Required
Inspection Requited
Sidewalk Required
Underground
A�
TY V�tlj C0111jectors requiffill
Vb. 111111wees DR sing
4101, - Imc 80462
7 'Ices.
WED
rouP uJI(toMod S4
(D
z
rx
Lu
W
z
a
z
Lu
BY
VARIANCE OR CU
SHORELINE OR ADB#
I INSPECTION
REQ'D
SEPA
COMPLETE
13YES 13NOI
CAN
ZONE
SIGN AREA HEIGHT
WAIVER 13
STUDY 13
nDqilkN
ALLOWED PROPOSED ALLOWED PROPOSED
IJO U* 'Llit 7% 1
LOT COV G
POSE SETBACKS (FT.)
ALLOWED ;;
S
IN
NT L/RSIDE REAR
z
IE
z
PARKING
REO'D . PROVIDED
Vj-
LOTAREA
PLANNING REVIEWED BY DATE
FT.) I REMARKS
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
si:�_E
TYPE.0 ONSTRUC(;N
21
C(
N,
I
NUMBER
OF
NUMBER OF
DWELLING
- -
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
STORIES
UNITS
REQUIRED
LOAD
76—ESCRIBE WORK TO 13E DONE
REMARKS
z
Ca 4n
Cra� CoMea- tt
ezA4-eC
fA:l-jc
GEOTECH REPORT
BY:
act 5_2 Q4J
STRUCTURAL DESIGN
BY:
VALUATION
$
an"
Description
FEE
Description
FEE
D IV t
Plan Check
State Surcharge
HEAT SOU CE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN ItHECK NO:
Plumbing
CIO
Base Fee
oo
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
e v
Engr. Review
E n g R
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
s
Engr. !nspection
E n 'n p
u
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
S
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Re v ie
Fire Review
F Ir e
Plan Chk- Deposit
F
Li IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
D
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
I nsp ec
Fire Inspection
r
F I e
Receipt #
x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Y
I
E
* FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
E
* DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
L and sca pe
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
�t
x —
Recording Fee
Record I ng
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 0 F
This application is not a permit until signed by the
.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
C
Building Official or his1hor Deputy� and Fees are paid, and
TION; AND
0
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
0 1 4
FOR INSPECTION
receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFFICI%SIC;,jW
--- a- - -
SIGN URE (OWNER R GEN DATE.TGNED
(425)
)DAT
771.0220
RELEASE DATE
AttENTION
EXT. 1333
IT IS UNLAWFUL TO USE OR OCPUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE - YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 / IRC110.
PINK -OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
i
0
M
--I -n
M
M
0
-10
0 C
M
M Z
C
0 -Ti
Irl
M M
0
0
0 M
C (n
9 Cn
M 0
Z
X
X
z
W
z
0
0
M
16