20050442A (2).pdf441/t.,7 DATE RECEIVED r •� /1 �-�, r
/ !r+ I! _(� J\ L 1��� PERMIT EXPIRES ! L' �J
RMIT
CITY OF EDMONDS Nu BER
CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAMEINAME OF BUSINESS ADDRESS Z 3 s-�s �(7 IfV/9Y V I kj4
r Wa4 f '.V r the
PLAT NAMEISUBUIVISION NO. LOT NO. LID NO.
w
MAILING ADDRESS/ LID FEE $
TESCPApproved 17
C 25MI5
Gt/ n PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Requited O
/_ Street Use Permit Required
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Required E3
sidewalk Required 17
/
F0O�� CI' l(O %2 y99underground Ei
,Z, REQUIRED FT Wem required EI
NAME/� METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO 0 Z
U K
W
t ADDRESSREMARKS w
X OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
v r,
IY W
Q
ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE ur
CITY ZIP TELEPHONE g
w
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBN INSPECTION SEPA
REQ'D I
I COMPLETED I EXEMPT
0 YES ONO
CAN ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNI,PARCQ.'•)�� � `.�
U
(� Jl� � � ` WAIVER 1 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 0
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR c7
f ❑ COMMERCIAL COMPLIANCE OR z
D(1 ADDITION1:3❑ CHANGE OF USE z
'tel MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE S
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑11GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER 19/ iimm
❑ CARPORT ❑ ROCKERY ❑ FIREALARM rf�y �/� / f �f
zo
(TYPE OF.L§E, BU INE S OR TIIT ) EXP IN:
p�
/� TYPE OF CONSTRUCTION CODE OCCUPg
A.7 GROUPfk'
NUMBER NUMBER OF 1�•
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS LOAD
REQUIRED CI YES
DESCRIBE WORK TO BE DONE
REMARKS
ILL X , /V GEOTECH REPORT
A/ �J BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE ,�'^�� /
Building Permit J v 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
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
J SEPARATE PERMISSION.
F Engr. Review
u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6), Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
A IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. 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 APPROVAL
GIVEN IS CORRECT; AND THAT 1 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 his/her 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 COMPENSATION INSURANCE AND RCW 18:27.
OFFICIALS SIGNATURE DATE
SIGNATURE (OWNER O T): DATE SIGNED (425) 67-27
J Vl
J`- 9 7/0 771=0220 OELEAS4
BY DATE
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 -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110• PINK -.OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES