20050500.pdfDATE RECEIVED
Ll .10D
Ll
P 2-1 :Z ff13
ERMIT EXPIRES
—1
CITY OF EDMONDS
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
1
SUITE/APTH
I
—1,10
OWNER NAME/NAME OF BUSINESS
. *�,
PLAT NAMEISUB DIVISION NO. LOT NO. LID NO.
UX MAILINGADDRESS
LID FEE S
0 Iq LJ
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
RW Permit Required E3
CITY ZIP TELEPHONE
EXISTING.--
Street use Permit Required [3
PROPOSED inspection Required 0
go _ I c;MrS
210
REQUIRED DEDICATION
Sidewalk Required 13
FT underground C3
Waing req d
-
NAME
METER SIZE
LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 11 NO 13
L)
'ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
UJI
W
z
a
u
z
W
CITY ZIP ONE
NAME
ENGINEERING REVIEWED BY DATE
ADDRESS
U
FIRE REVIEWED BY
DATE
CITY ZIP TELEPHONE
U_
0
U
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR CU
SHORELINE OR ADB# INSPECTION SEPA
REQ'D co
I JOYES
13N 01
CA#
ZONE SIGN AREA HEIGHT
-j PROPERTY TAX ACCOUNT PARCEL No.
<
WAIVERO
PROPO
PROPOSED SED
ALLOWED ALLOWED
0
W
_j
STUDY C3
,
NEW RESIDENTIAL PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMMERCIAL COMPLIANCE OR
ADDITION 13
CHANGE OF USE
z
1:1 MIXED USE
PARKING
LOT AREA _[T�EVIEWED BY DATE
'5
REMODEL 1:1 MULTIFAMILY El SIGN
REO'D PROVIDED
0.
GRADING FENCE
REPAIR 1:1 CYDS X FT.)
REMARKS
DEMOLISH 13 TANK OTHER
jkri�
GARAGE RETAINING WALL FIRE SPR�I`NKLEIR
1:1 El FIREALARM
z CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR AC TIVITY EXPLAIN:
TYR4 OF C20STRUCrN OCCUPAN
GROUP
Lu NUMBER NUMBER OF
OF DWELLING
I I
SPECIAL INSPECTI
CONSULTANT OCCUPANT
0 STORIES UNITS
—
REQUIRED E3 YES
LOAD
DESCRIBE WORK TO BE DONE
REMAR;%.j.
z
6-C4 CV A 14—
GEOTECH REPORT
_--2a
. I
BY:
15, Cie adi cp� LO
STRUCTURAL DESIGN.
BY:
15'
VALUATIO'W—
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Pe rmit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
It SEPARATE PERMISSION.
Engr. Review
2
Ix PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT,.,SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
U)
Fire Review
Plan Chk. Deposit
U) IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
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
Landscapelnsp.
Total.Amt. Due
C NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
X1 —
Recording Fee
Receipt#
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
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-
CAL
Building Official or his/her Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE
IN VIOLATION Of -THE LABOR CODE OF THE STATE OF WASHINGTON RELATING T
FORINSPE
TION receipt is acknowledged in space provided.
WORKMEN'S � �ATION INSURANCE AND RCW 18:27.
OFFICIALS SIPNATURE DATE
SIGNATUR 0 AG DATE SIGNED
Z
rcz�
(425)
6 Ly
771-02
RELEASED BY DATE
ATTtNTION
EXT. 1
3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
.... .— . �111%�
A FINAL INSPECTION HAS BF-ILN MAuL AND ArrmvvmL. OR A CE-Ri ORIGINAL -FILE YELLOW - INSPECTOF
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD ASSESSOR
10104 PRESS HARD YOU ARE MAKING 4 COPIES
z
0
M
-4 -n
M
M.0
0
10
0 C:
M
M z
C _z
>
W
o n
n
M M
0
0
0 M
C (n
r. Cn
M 0
Z
3:
>
z
_4
x
Cn
z
0
0
M