20050423.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA /NAME OF BUSINESS
MAILIN G AbDRESS
lay/,
CITY ZIP TELEPHONE
15,:-brillAlds !0':ty4 I �J--/
NAME
ADDRESS
*Lq I I Y!::� [PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITEIAPT#
PLAT NAMEISUBDIVISION NO
LOT NO.
LID NO
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
13
13
Street U50 Parnid Required
13
EXISTING PROPOSED
Inspection Requited
13
Sidewalk Requited
13
REQUIRED DEDICATION FT
underground
Mind required
0
Ell
METER SIZE �ftE SIZE NO. OF FIXTqRES PRV REQUIRED
YES13 NOO
z
W
REMARKS
W
z
OWNER/CONTRACTOR RESPHRE FMAfl9H04_qTROL/DRAINAGE
6
MU-Su'T BE PRESENT FOH
z
W
f,
NK
ME.
NEMOVAL.,
OR CAP
NAME CEILM
0 0 ENGINEERING REVIEWED 13Y -7
M ADDRESS q) C)
0
L)
10—e. 96)x FIREREVIEWED BY DATE Lu
cify ZIP TELEPHONE
z
0
SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER 31RATIO �T �E Y VARIANCE OR CU
CFKCKED BY REO'D COMPLETED I EXEMPT
13YES 13NO
CAN ZONE SIGN AREA HEIGHT
j PROPERTY TAX ACCOUNT RCE 0 1 OWED , PRO PROPOSED
W 00 t 66
WAIVER 13 ALL POSED ALLOWED
Pf STUDY 13
00,53L
PRO
NEW QZESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) POSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
z
CHANGE OF USE z
MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE 15
REMODEL MULTIFAMILY SIGN REQ'D PROVIDED IL
REPAIR GRADING FENCE
1:1 CYDS ( X FT.) REMARKS
1:1 DEMOLISH [B-TANK OTHER
z 11 GARAGE, RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY 'elp FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVIT)5XPLAIN: 1414��A CLUJ V k
P�'�A TYPE**O �,S@R C7L CODE OCCUPAN
1111, GROUP
L)
ILL! NUMBER NUMbERb
0 OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
M STORIES UNITS LOAD
0 1 1
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
z
pa GEOTECH REPORT
BY:
HI LSe 2 7 S� zrllAld STRUCTURAL DESIGN
by'.
Vlelvldf4d L"llei, vives LUATION
f
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit 00 City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
IX PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
ul
136 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
tn
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
C
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. 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 APPROVAI
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Tips application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Ot'licial or his/her Dt )uty and Fact; are paid and
WILL BE EMPLOYED
0
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON ihl�
IN VIOL Na8 CODE OF THE STATE OF WASHINGTO14 RELATING TO FOR INSPECTION receipt i(a nowled ud in space P10,vided
ATION OF THE,kAi_
WORKMEN'S COMPENpAfl-O-RIN"ANCE AND RCW 18:27. OF TURIF DATE
__SIrjNATjXE (Olii�YER &q�A DATE �GNED (425)
FIL
2 -0220 RELEA5ED DAtt
771
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILF - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
1
0
M
0 M
C
MO
0
10
0 C
--j K
3: M
M Z
0-1
C
co
0 -n
x
M M
0
0 M
C C/)
r, C/)
Q C-)
Z
z
Cl)
z
0
1
0
M
1110
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT ING DIVISION
FROM:
-FIRE DEPARTMENT DATE 5'(ZA0
PlMaP SIGN
ENGINEERING DIVISION DATE—
nyAsESIGN
z
PLANNING DIVISION DATE
0
PLF"Sm
M
PROJECT
5i
Fn
SITEADDRESS
M
:C
0 5- 0�13 INSPECTED V(.2.4 /Or-'
M 0
0
PERMIT 1� -DATE
C:
--ADB#
X M
DESCRIPTION OF WORK TO BE INSPECTED__V_Lr::J
M Z
z
A field inspection was conducted to determine final compliance with% approved plans.. Final approval
2E
Cn
denotes that there are no objections from the above signed Department to the, release, of
0 -n
PERFORMANCE BONDS and the granting of
-n
M M
GRANT FINAL PROJECT APPROVAL
0 M
-0
C (n
Q 0
z
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
>
u Copy of CONDITIONS. given to owner/contractor by inspector
z
X
cn
z
0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0
M
Q COPY Of CORRECTION NOTICE given to owner/contractor by inspector
2.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.doc.l:tenip:bldg:.formsIO/OI