20050465.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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CITY TELEPHONE
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PERMIT EXPIRES
PERMIT
NUMBER 6c,
JOB
ADDRESS 7�11
SUITE/APT#
PLAT NAMEISUBDIVISION NO.
LOT NO,
LID NO
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
EXISTING -----PROPOSED
Street Use Permit Required
Inspection Required
Silowatk Required
REQUIRED DEDICATION
FT
Underg(ound
Witin2 ri-quired
METER SIZE
LINE SIZE
NO. 2gXTURES
PRV REQUIRED
YES 13 NO E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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REVIEWED BY . DATE
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STATE LIC ENSE NUMBER EXPIRAT ION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBI INSPECTION SEPA
REO'D COMPLETED EXEMPT
13YES _ONO�
CAN ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. _(zL.L_j_
WAIVER [3
ALLOWED PROPOSED ALLOWED at"POSEO
00 15i`51-5.5 o6o 614 oO P STUDY 13
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NEW §9RESIDENTIAL LUMBING MECH LOT COVIPERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED ROP SED] FRONT SIDE REAR FRONT UR SIDE REAR
1:1 COMMERCIAL 0 z
COMPLIANCE OR
154 ADDITION
1:1 MIXED USE CHANGE OF USE
14 REMODEL PARKING" LOTAREA PLANNING REVIEWED BY. DA
El MULTIFAMILY SIGN REDID I PROVIDED
FENCE
1:1 REPAIR GR
7�G CYOS x FT.) REMARKS
OTHER
13 DEMOLISH TANK
z E]GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FIREALARM
t- (TYPE OF USE, BUSINESSOR ACTIVITY) EXPLAIN:
2: TYPE 0�1'_ LICTION CODE OCCUPANT
GROUP
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OF DWELLING SPECIAL INSP
,j(TION CONSULTANT OCCUPANT
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DESCRIBE WORK 10 BE DONE REQUIRED YES
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Axn) I -r io N s GEOTECH REPORT
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VALUATION
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Description FEE. Description FEE
C"iiliie�r Plan Check State Surcharge
HEAT 9OURCE LOTSLOPE% VESTED DATE
61 j6W45 110 Building Permit City Surcharge _15
PLAN CHECK NO: — Plumbing A Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
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 19.00.005A)(5) /4K
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
in PlanChk.Deposit
U) *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
7z EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAr3ES 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 Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x 111111111 Recording Fee Receipt 4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPRdVAL
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 his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowiedged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S C�SATION INSURANCE AND RCW 18:27.
0 SIGNVI DATE
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K]I�NATIJIRkj&WNER.'� GEN7U. A DATE SIGNED (425)
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L 771-0220 it 6ATE
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ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L I I
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 I IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
1IGINAl, - FIV YELLOW - INSPIFICTC
'W�ER GOLD - ASSESSOR
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EX15TING: 5 BF.
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pRopo -D AC)DITION: 118 5 2411 5F. (24.659. RIDGE:
TOT NEW 5.F., 2&3(o APPROVED BY PLANNING
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A)70f- Or- RH BY EINGINEERING 145 5F.
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1045' REMOVING C>EC
Conw tl D FROF05ED 5UILDING ROOF: LINE: 213 5.F.
Setbacks Reauimd Actual Date: STRE�T FILE
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FINAL jmzoncr A P P R'
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GRANT FINAL PROJECT APPROVAL
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HNAL PROJECT APPROVAL FORM
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PERFORMANCE BONDS and the granting of:
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Date Signature
I:tetlll3:bldg:forii-L,;:ocaprvI 3/25/04