20050576.pdfN� DATE RECEIVEDt_�"'
J e,5 1 PERMIT EXPIRES .'
PERMIT
CITY OF EDMONDS NUMBER -�' �-- C' -
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS I< Jr
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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MAILING ADDRESS j/ LID FEE 5
z!f PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved
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rlw •v t RW PermdRequvod 0
Stream Use PermitRequited f7
CITY ZIP TELEPHONE �`/J�ay Tr . t rZ> EXISTING PROPOSED Inspection Required
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Sidewalk Requited p
Fl�rjl (whS fiv/2 7 Zr' ys� j7e REQUIRED DEDICATION FT Underground E3
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PR V REQUIRED
to LLI� Il-/� r / / YES (] NO 0 E W
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ADDRESS REMARKS W
U _ OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE E
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CITY ZIP TELEPHONE W
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NAME CBL#
ENGINEERING REVIEWED BY DATES n
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FIRE REVIEWED BY DATE �
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STATE LICENSE NUMBER / EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
f REO'D . I COMPLETED I EXEMPT
0 YES O
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT. PARCEL NO. 1 n
JO 0L/ �� s/ 0 • 4/ 0 "� ST ly YR 0 ALLOWED PROPOSED ALLOWED PROPOSED
NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE t I , — ' z
❑ REMODEL ❑ MIXED USE ❑ PARKING LOT AREA JPLANNING REVIEWED BY DATE ''7 g
❑ MULTIFAMILY SIGN REQ'D PROVIDED y
G A ING FENCE �_ 4
❑ REPAIR g� CYDS ❑ ( X FT.) R S
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❑ DEMOLISH ❑ TANK ❑ / t t
GARAGE RETAINING WALT. FIRE SPRINKLER0.
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z ❑ CARPORT Li"QQNGiW ❑ FIREALARM f • _
a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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aS' 2 '��� TYPE F C NSTRUCTION GROUP
ANT
Ul NUMBER NUMBER OF
mOF DWELLING / SPECIAL INSPE TION CONSUL NT OCCUPANT
O STORIES UNITS ( LOAD
REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REP
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BY: Ic h l(J�!
M &PO 47. /30 -C k `I6a,t 19 5Ar%e,-i a L.iikl 6W) VALUATION
$ --��
Description FEE Description FEE
Plan Check "" Stale Surcharge
HEAT SOURCE LOT SLOPE%VESTED DATE
/Lf — Building Permit City Surcharge S
L) T7000
PLAN CHECK NO: , r Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical /
H BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBSt SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
� Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) t" 1
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)`
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
f EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEESt AND AGENTS FROM ANY AND Fire Inspection Receipt # 2
e ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY ff
= 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
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE Tr1AT 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 Building Official or tits/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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 18:27.(4��� F ALS SIGNTURE AT
SIGNA�U W R AGENTj: DATE SI(GNED%) t L C
7714220 RE?D S BY �J -r 'DATE
ATTENTION EXT. 1333 C
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 INSPEC OR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109/ IBC1101 IRC110. PINK -OWNER GOLD •ASSESSOR
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RECEIVED
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JUL 2 8 2005
DEVELOPMENT SERVICES CTR. o
CITY OF EDMONDS
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