20050524.pdfDATE RECEIVED
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CITY OF EDMONDS ZONE NUMBER• j
CONSTRUCTION PERMIT APPLICATION JO° (P/25SUITE/APT#
ADDRESS
ME/NAME OF BUSINESS S /rOWNEy�7
Git-� 1Z✓1 � e hl PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
¢ MAILING ADDRESS LID FEE f
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
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O o r% • Street Use Permit Req'd
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Requlrad Q
Sidewalk Required Q
REQUIRED DEDICATION Fr _ Undeti���Witing rand tt(///111��� v ,1.• 1 ! _ / / ldna required Q
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED O
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ADDRESS REMARKS z
I. [,+ OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CI ZIP TELEPHONE
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NAME,
L O r dfO 1y1w1 -� "' L- • r ENGINEERING REVIEWED/DATE
a ADDRESS
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CITY 111ZIP TELEPHONE41 JA 7 "le 9 /^,
STATE CENSE NUMBER EXPIRAT OND E C CKED Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
F 7 REQ'D POSTED
Pf D��"(oSL P .5 Q�// ❑YES ❑NO I
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNTPARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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❑
NEW RESIDENTIAL LOT COVERAGE, REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ❑ ❑ PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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[j�ADDITION COMMERCIAL COMPLIANCE OR
❑ CHANGE OF USE
PARKING LOT AREA 17LANNING REVIEWED BY DATE n.
E24EMODEL ❑ APARTMENT ❑ SIGN REO'D PROVIDED
❑
REPAIR GRADING FENCE ❑ CYDS ❑ ( X FT) REMARKS
❑ DEMOLISH ❑ TANK!7T OTHE -
❑ GARAGE CARPORT ❑ ROCKERY G WALL ❑`J RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT
fcAA /J rq�3 GROUP
NUMBER NUMBER OF CRITICAL
rpp OF DWELLING (%� AREAS / SPECIAL INSPECTOR JAREA OCCUPANT
O STORIES: UNITS /` NUMBER REQUIRED ❑ YES t�pO pLOAD C'
DESCRIBE WORK O BE DONE J
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REVD 9
Coe -A 444,4A,411 r"
VALUATION $
Description FEE Description FEE
Plan Check
HEAT SOURCE. GLAZING % LOT SLOPE %
Building J -
PLAN CHECK NO: 0 VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC Gradin Recording Fee
i DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 9 ecorg
3SEPARATE PERMISSION. ,-
a Engr, Review City Surcharge r
o� PERMIT APPLICATION: 180 DAYS
C61 PERMIT UMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Mitigation Plan Chk Deposit C� Miti
2 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Trafficg
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF %1
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection } Total Amount Due --�=-
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_ NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE'PROVISION'
Landscape lnsp. Receipt 8
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- CALL This application Is not o permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Foos aro paid, and
IN VIOLATION OF THE LA99A,,CoODE'OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in spacu provided.
WORKMEN'S COMPENSATff IVSVRANCE AND RCW 18.27.
it E GATE
SIGNATURE (OWNER OR DATE SIGNED (425),
2�
771-0220 E A BY DATE
LATT TION EXT 1333 { ,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL r'
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771 m0221 .
ORIGINAL -FILE 9 YELLOW • INSPE OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER • GOLD - ASSESS R
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