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20050518.pdf-ter--_ DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS �T_0 *rt'f fQl7eK:s6•1 ZIP TELEPHONE q $D LCN 11125 7? y yiyt o: NAME. Y C�� PERMIT EXPIRES �- PERMIT NUMBER JOB ADDRESS ELI. PAT NAMEISUaDIVISION NO. LOT PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING _ PROPOSED _ REQUIRED DEDICATION FT METER Ste- "CTIQE3RE "'" "—'f7i} ! C� t2iiii Flee trical REMARKSI OWN ERIC CIN 7SA FJKREBPO WLrFdA' RA;IC SUITEIAPT# LID NO, LID FEE S TESCP Approved 11 RW Permit Requ,rod 13 Street Use Permit Required 13 Inspection Required Q Sidewalk Required .13 Underground Q Wiring required 17 11i�r PRO REdUIRED ruill frmn NO O = 4 jefE RAINAGE z . �.�.�. w ,.rmc CBL# In addition to the required ADDRESS Cooet 001e4k t : 17411 i e 11'00 `1872 F.NGINEERI re/rel valve, an appituftd ;L(A10 21"n A..,, A 19, listed expansion tank shall be C ZIP TELEPHONE CITY FIRE REVIE 4mtalled on all hot water tans �l+-1 223 .360CoS 43402 IUPC 6(1.8 STATE LICENSE NUMBER EXPIRATION DATE BY VARIANC r011ot T' " PA RE [COMPLETECY EXEMPT Goo Aw +F o yykm ab 2© 1 GA PIPE FEST PROPERTY TAX ACCOUNT PARCEL NO. CA# Rn � � 6� P p N MV EC '/�i R HEIGHT J 0661122 odObo DU WAIVER i� 1tL�aW�ED "F•Rb�tl MIOWED PROPOSED STUDY O ❑ NEW ❑^RESIDENTIAL PLUMBING / MECH LOT COVERAGE K1iOlt�) PROPOSED SETBACKS ) ALLOWED PROPOSED (jjj01{II I_ ��paj FRONTUR SIDEREAR ❑ ❑ ADDITION COMMERCIAL COMPLIANCE OR ❑ MIXED USE ❑ CHANGE OF USE •�-� ---- ,,CC" ❑ REMODEL ❑ P e 19 o1bTiAR9MAC JiLAWMAO E��S IFIBq 'r9E ❑ MULTIFAMILY SIGN REQ'D rVID D El REPAIR E] GRADING CYDS ❑ FENCE n iU i11t'i ing:1 pliances passing ( X FT.) REMAR through un ente Spaces. DEMOLISH ❑ TANK((❑�� OTHER _ ❑GARAGE RETAININGFIRE CARPORT ❑ ROCKERY WALL L.! FIRE ALARM SPRINKLER a(TYPE OF USE, BUSINESS OR ACTIVITY)I/E v N TR OCCUPANT GROUP j G NUMBER NUMBER OF op OF DWELLING SPECIAL INS P TION CONSULTANT OCCUPANT O STORIES UNITS LOAD DESCRIBE WORK TO BE DONE � REQUIRED D YES h fir✓%I 4 �-- REMARKS Ir 002 C1904 0glee f"Q del OaA4 d GEOTECH REPORT BY: Y STRUCTURAL DESIGN .h. •. BY: Mir, tiv ; ii 1A -L J CLJ�r VALUATION it WWLV) ba kw 4 Description FEE Description FEE Plan Check Slate Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE r Building Permit City Surcharge PLAN CHECK NO: Plumbing ` Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading t SEPARATE PERMISSION. rc PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review PERMIT LIMIT: SEE ECDC 10.00,005(A)(8) IEngr, Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION g ' p *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INOEMNIFY, 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 SIIALL 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 I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and 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 10:27, OFFICIA S SICPATURE ATE SIGNATURE (OWNER O GEN DATE SIGNED (425' 4RLEA 771=022U ED BY DAIE ATTENTION Apr 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 / IBC110 I IRC110. PINK -OWNER •GOLD • ASSESSOR 1010' PRESS HARD - YOU ARE MAKING 4 COPIES Lu U. 0 z a m O 'i M T —I C mom. 0 O n C _ M M 10� z 111 _ 0 0 i MM OC 0M M0 r Z rn �r D z z 0 M