20050558.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
tee Mskew kG 1 r 5
MAILING ADDRESS
a:s da yo
CITY ZIP - TELEPHONE
�.-clv�uv.�cS a - �-o C aS • - � �.
NAME
ADDRESS
CITY ZIP TELEPHONE
kvWk 1zo 3-75 CyaS 111q -5b tiff
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
jf\Put- UI '044' 60 `1-cj-b " )1h
PROPERTY TAX ACCOUNT PARCEL NO. a �y OCj a.tjUO-' D •j J&J* CtN. y
J d
nt NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑ MIXED USE CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY SIGN
❑
GRADING FENCE REPAIR ❑ CYDS ❑ ( X FT.)
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
a (TYNVO
F USE, BUSINESS OR ACTIVITY) EXPLAIN:
\00
w NUMBER NUMBER OF
PERMIT EXPIRES l I IaC L
PERMIT
NUMBER r S�
JOB �` ' SUITE/APTa
ADDRESS •� �� �� �%. ` �
PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAI. STREET MAP TESCPApproved O
RW Permit Required 13
Street Use Permit Requited Q
EXISTING ,i. ; ROPOSED —" inspection Required O
Sidewalk Required CI
UndeuREQUIRED DEDICATION FT _ Wain r requit
qO
— wn,n cored O
METER SIZE LINE SIZE wt NO. OF FIXTURES PRV REQUIRED
YES O N013 z
AU
AU
REMARKS w
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
O
z
w
NEERRINGREVIEWED BY
NEd m
REVIEWED BY
•f
DATE
W
LL
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
p REQ'D COMPLETED EXEMPT
A J/Y i � ATI- I, YES B NO I I x
CAti ZONE SI N AREA I HEIGHT
"wpWAIVER O ALLOW D POS�E.D�( ALLOW D PROPOS
STUDY [3 ��� ,/f�� iloii
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
15's l N 0 CAAAV bl5' z
PARKING LOTAREA PLANNING REVIEWED BY DATE g
REQ'D PROVIDED
oow�' I 00� I e W (.ITLu,00tto, DqjD8 jD 6-
k AMAR`+ 1 ✓1 1%4q n I i 4-1,15 M III I /i V 1/� n /7 in G«C
L �.�0.020•
7 -(a -os
�e4 OCCUPANT
GROUP
OF , DWELLING SPEC191.INSPECTION CONSULTANT OCCUPANT
STORIES UNITS LOAD
REQUIRED � YES
DESCRIBE WORK TO BE DONE
ti ' L k% 1 1� Yj eL t S� REMARKS
411,
I , 11 l 4 1 l ( 11 GEOTECH REPORT
BY:
STRUCTURAL DESIGN
-' - - 1 v -.. BY:
^ r Ir 1 s. .
iCfi;T2.� ' I VALUATION
Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE /
Building Permit City Surcharge
PLAN CHECK NO: ��I Plumbing Base Fee
l
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
J SEPARATE PERMISSION.
E Engr. Review
u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(4)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT; ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
L IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # �►.S
= 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
i NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO.ENFORCE ANY ORDINANCE PROVISION"•
Recording Fee Receipt # .
I HEREBY ACKNOWLEDGE THAT 1 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 Building Official or hisiher Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LA CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI NEIN URANCE AND RCW 18:27. I A SIGNATUR D TE
SIGN RER•E (OWNER ORA ENT DATE SIGNED (425)
L� .- .•U J 771w0220 REL BY E
ATTENTION EXT. 1333 1�`
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- 0 1 INA •FILE • Y OW -INSPE TC
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110. K - WNER GOLD ASSESSOR
1004 PRESS HARD - YOU ARE MAKING 4 COPIES
Z
O
0
M
OM
rn
O
O0
_ M
MZ
p �
DZ
o�'
mm
O lr�
nm
r Z r
D
i Z
N
Z
O
n
IT!