20050441.pdfDATE RECEIVED
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PERMIT
PERMIT EXPIRES q-21' C) �
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BU' ESS �j� � // �/ •-� /
V I s 1 , &A � r. r`) PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILINGADDRESS t ,r• 1 1
CITY ZIP TELEPHONE
ADDRESS
ZIP
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NAME CBL#
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FIRE REVIEWED BY DATE �
Z CITY ZIP TELEPHONE
O u:
U 1q VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D. COMPLETED ExEMPT
OYES 13 NO
CA# ZONE SIGN AREA HEIGHT 0
PROPERTY TAX ACCOUNT PARCEL NO.
Q WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
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STUDY 13
❑ NEW ❑ RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑CHANGE OF USE _
ElMIXEDUSE PARKINGLOT AREA PLANNING REVIEWED BY DATE a
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
GRADINGFENCE
REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER /1�
GARAGE RETAINING WALL FIRE SPRINKLER
_ ❑ CARPORT ❑ ROCKERY ❑ FIREALARM / /
!
(TYPEOF USE, BUSINESS ORA IVITY) EXPLAIN:a TYPE OF CONSTRUCTION OCCUPANT
Y "ry,L✓hvGROUP �
oNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES UNITS �17jj LOAD
0 REQUIRED
DESCRIBE WORK TO BE DONE
,r� ,� REMARKS
/ �" ! V ol/A "l GEOTECH REPORT
, BY:
e//l !� wv zy
Ag �%I STRUCTURAL DESIGN
�
N - / BY:
/ V G'� �� /G'� VALUATION
$ 3300�
Description FEE Description FEE//''
Plan Check165
State Surcharge Sv
HEAT SOURCE LOT SLOPE% VESTED DATE `
Building Permit � City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION,
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk, Deposit
W 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
BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT Landscape Insp. Total Amt. Due
= 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; ANR THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a permit until signed by the
THE OWNER. EEE COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hlslhor Deputy: and Fees aro paid, and
TION; AND/ IN WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOL I T E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
WORKM P NSURANCE AND RCW 18:27. OFFICIALS SIGNATURE DATE
sIGN N R AGENT): DATE SIG ED (425)
4.0
771m0220 to FfE ABY DATE
AT ENTION EXT. 1333 flAj
IT UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
INAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE • YELLOW - SPECT R
ATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC1104 PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
❑
❑
RW Permit Required
Street Use Permit Required
❑
EXISTING PROPOSED
Inspection Required
❑
Sidewalk Required
❑
REQUIRED DEDICATION
F'rUnderground
Wiring required
C3��-1
❑
METER SIZE LINE SIZENO.
OF FIXTURES PRV REQUIRED
YES O NO O
T
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EW
REMARKS
W
x
OWNER/CONTRACTOR RESPONSIBLE
FOR EROSION CONTROL/DRAINAGE
5
.a
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NAME CBL#
o its ril LLOIrJt/ C . �C7 ENGINEERING REVIEWED BY DATE
m ADDRESS
O
2Hljj 9;n
FIRE REVIEWED BY DATE �
Z CITY ZIP TELEPHONE
O u:
U 1q VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D. COMPLETED ExEMPT
OYES 13 NO
CA# ZONE SIGN AREA HEIGHT 0
PROPERTY TAX ACCOUNT PARCEL NO.
Q WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
W , i �.cx)a
STUDY 13
❑ NEW ❑ RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑CHANGE OF USE _
ElMIXEDUSE PARKINGLOT AREA PLANNING REVIEWED BY DATE a
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
GRADINGFENCE
REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER /1�
GARAGE RETAINING WALL FIRE SPRINKLER
_ ❑ CARPORT ❑ ROCKERY ❑ FIREALARM / /
!
(TYPEOF USE, BUSINESS ORA IVITY) EXPLAIN:a TYPE OF CONSTRUCTION OCCUPANT
Y "ry,L✓hvGROUP �
oNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES UNITS �17jj LOAD
0 REQUIRED
DESCRIBE WORK TO BE DONE
,r� ,� REMARKS
/ �" ! V ol/A "l GEOTECH REPORT
, BY:
e//l !� wv zy
Ag �%I STRUCTURAL DESIGN
�
N - / BY:
/ V G'� �� /G'� VALUATION
$ 3300�
Description FEE Description FEE//''
Plan Check165
State Surcharge Sv
HEAT SOURCE LOT SLOPE% VESTED DATE `
Building Permit � City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION,
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk, Deposit
W 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
BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT Landscape Insp. Total Amt. Due
= 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; ANR THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a permit until signed by the
THE OWNER. EEE COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hlslhor Deputy: and Fees aro paid, and
TION; AND/ IN WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOL I T E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
WORKM P NSURANCE AND RCW 18:27. OFFICIALS SIGNATURE DATE
sIGN N R AGENT): DATE SIG ED (425)
4.0
771m0220 to FfE ABY DATE
AT ENTION EXT. 1333 flAj
IT UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
INAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE • YELLOW - SPECT R
ATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC1104 PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
0
m
-i mn
Cm
I. mo
--I
OC
I mz
p --11
C Z
l �
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Mn
mm
O to
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imZ"i
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