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20050499.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS �r M86 ma IY w MAILING ADDRESS 0 O Roll 5T CIITTY' p ZIP TELEPHONE ��G��S lad ��✓/'=7Ty�a1�3r NAME U / W ADDRESS [PERMITEXPIRES I� , PERMIT NUMBER JOB SUITE/APTI7 ADDRESS 6 PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE 5 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O RW Permit Requited 0 Street Use Permit Required 0 EXISTING PROPOSED inspection Required 0 Swlawalk Required 0 REQUIRED DEDICATION FT Uodwground 0 Witino required 0 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13 NO CI z R W REMARKS W OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z O W NAME CBLq I�� /v C^ U0/(% l� ENGINEERINGR I D© I AL I. QB CAP DATE M ADDRESS URax Q �¢ `/92 LaV FIRE REVIEWED BY DATE UJI Z CITY ZIP TELEPHONE ul U Se �� a oG ��3<< SEPA STATE LIC NS NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBp INSPECTION ED /�I REDO COMPLETED EXEMPT / C o (. (/ / n O OYES D NO -' PROPERTY TAX ACCOUNT ARC NO. G' (]�) Vx CAtt ZONE SIGN AREA HEIGHT ul 4 a� ��'� O V STUDY I] ALLDWEO PROPOSED ALLOWED PROPOSED .j 1 ❑ NEWRESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR t7 ❑ COMMERCIAL COMPLIANCE OR _ ❑ ADDITION11:1 11 CHANGE OF USE i ❑ MIXED USE PARKINGLOT AREA PLANNING REVIEWED BY DATE 5 ❑ REMODEL 1:1 MULTIFAMILY 11 SIGN REO'D PROVIDED ❑ GRADING FENCE REPAIR 1:1 CYDS ❑ ( X FT.) REMARKS ❑ DEMOLISH I JL TANK ❑ OTHER Z ❑GARAGE RETAINING FIRE CARPORT❑\ ROCKERY WALL 1:1FIREA ARM SPRINKLER a(TYPE O� USE, BUSINESS OR ACTIV EXPLAIN: % G TYPE OF. TR CT CO OCCUPANT /� GROUP cN BER NUMBER OF OF DWELLING SPECIAL I SPECTION CONSULTANT OCCUPANT O 'STORIES UNITS LOAD 0 REQUIRED DYES DESC E WORK TO BE DONE REMARKS z Roa 1 P~ e /117 c a 1 r GEOTECH REPORT BY: m ifge d a"e �(r( `( a /v STRUCTURAL DESIGN BY: l BSP 4 /N r! ,k VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE / Building Permit P City Surcharge PLAN CHECK NO: Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical H BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading J SEPARATE PERMISSION. N Engr. Review re 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 H 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF N EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # a 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 APP A 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• CALLBuilding 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 LAB ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledg in space provided. WORKMEN'S COMPENSATION INS NCE AND RCW 15;27, OFFI S T E DAT yRE (O NER A ►: / DATESI EDS (425) •� C� f , 771 1 w0220 RELEASED DAT ATTE ION 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 w YOU ARE MAKING 4 COPIES . I.i O m cM M -1 O OC Mm 10 C Z T MM 0 G) 0 M e Z 0' Z Z z O n M