20050529.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
F� c--, 4 1 P I L 1, — f z qA <
MAILING ADDRESS
(JA,
I
CITY ZIP ELEPHONE
-7
-,-af 9<91 b W 1-2-0 61,12
NAME
PE RMIT EXPIRES
PERMIT
NUMBER
JOB
le C4
ADDRES§4::�)
�JITEIAPT$rl
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approve.1
RW Permit Required
Street Use Pertnit Required
[3
EXISTING X PROPOSED
inspection Required
E3
E3
Sidewalk Required
(3
REQUIRED DEDICATION FT
underground
Wirinq required
L3
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
IL
I
YESM NOO 9
_V
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
cc
M
z
E5
64,) 0
z
NAME
ENGINEERING REVIEWED BY. DATE
o: ADDRESS
U
< FIRE REVIEWED BY DATE
z CITY TELEPHONE
0
I — SHORELINE ORADB11 INSPECTION SEPA
MBE REQ-D COMPLETED EXEMPT
.P VARIANCE OR Cu
STATE LICENSE NU EXPIRATION DATE CHECKED BY
T C3 YES E3 NO
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCPUNT P�RCEIL NO.
WAIVER 13 ALLOWED I PROPOSED ALLOWED I PROPOSED
W I q 00 a C)0 STUDY 0
NEW RESIDENTIAL LUMBING if MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
�p ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMMERCIAL COMPLIANCE OR z
ADDITION 1:1 1 1 E
MIXED USE CHANGE OF USE I z
PARKIN LOT AREA PLANNING REVIEWED BY DATE
KREMODEL 1:3 MULTIFAMILY SIGN REQ'D PROLDED
GRADING FENCE
REPAIR CYDS ( X FT.) REMARKS
OTHER
11 DEMOLISH El TANK 1:1
z E]GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
9
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TYPE IDF&2STRUCTION OCCUPAN
re IL GROUP
L)
En
NUMBER NUMBER OF
OF DWELLING SPECIAL IFWECTION ONSULTANT OCCUPANT
0 STORIES e_', UNITS REQUIRED 13YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
A14ux�_, GEOTECH REPORT
BY:
t
STRUCTURAL DESIGN
BY:
VAQUATION
6:�� 0 /-DL41 -�3
$ coo -
0A
ow*7 0,111efid Description FEE Description FEE
Ii J_j 0, (Aj _1�; I V%. Plan Check State Surcharge 414
HP,AT SOURSE LOTSLOPE% VEbTED DATE
Building Permit City Surcharge 15, 00
PLAN CHECK NO: Plumbing Base ee nc)
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2— Engr. Review
1z PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Lu
It. 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 Fire Review Plan Chk. Deposit P6
in
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
x d
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Y ORDINANCE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT If I
.11 50
01 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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Bolding official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED fecept is acwowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
S SIGNATU E
(425)
iEjOWNE OR WAGE J. DATE SIG
s5prdl A .165
4,
771-0220 IDf
R_ ED Y
ATTtNTION STRUCTURE UNTIL EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
�AIG FILE OW INSPECTOR
P aL
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. F I#OWNER 0 - 'ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
4
0
M
-4 -n
M
C
ITI 0
10
0
0 C
--I r,
X M
M z
jO -4
C _z
E:
o -n
M M
0 C5
0 17,
0 M
C
M 0
Z r-
z
z
0
0
M
NOTIbE:' IF THE DOCUMENT. IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.