20050591.pdfDATE RECEIVED w
rl liq 101 PERMIT EXPIRES 4)1 IC14�
CITY OF EDMONDS
PERMIT R 0200 -0sq
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAMEINAME OF BUSINESS K/C.
PLAT NAME/SUBDIVISION NO. LOT NO. LID O.
MAILING ADDRESS G LID FEE $
100 1 V `� In ( 6 tLIL (i(�A\ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required O
RW Permit roqu,red
Street use Permit Required 0
CITY ZIP TELEPHONE EXISTING PROPOSED Inspecuan Required
Q Sidewalk Required I'
Eey� 6 N es�S l �U� % REQUIRED DEDICATION FT W,nnq re corded O
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES la NO U _
W
ADDRESS REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
O
z
W
NAME
ADDRESS
CITY
k-\-V^1Vt-CLLe/wb4
STATE LICENSE NUMBER
4�
ZIP TELEPHONE 0
�3 S2 t
EXPIRATION ATE
PARCEL NO.
❑
❑ RESIDENTIAL NEW ❑ PLUMBING /MECH
SOMMERCIAL COMPLIANCE OR
❑ ADDITION MIXED USE CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY SIGN
❑
REPAIR ❑ GRADING CYDS E3FENCE X
❑ DEMOLISH ❑ TANK OTHER
IRE S
_ ❑ CARPORT 1:1 ROCKERY GE RETAININGWALL ElFIREALARM RINKLER
0 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: -- d
TYPEAF CO STRU TION CODE GROUPANT
w NUMBER NUMBER OF ] '
C OF DWELLING / SPECIAL INSPECTION CONSULTANT OCCUPANT
MSTORIES UNITS _ LOAD
0 REQUIRED 1. YES -
DESCRIBE WORK TO BE DONE
REMARKS
Viol v ti�k �— `L� b�I. / GEOTECH REPORT m
STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check , Ov Slate Surcharge
HEAT SOURCE LOT SLOPE° VESTED DATE i
Building Permit , City Surcharge 1
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradlfl
DONMAIN (CURBS,. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
J SEPARATE PERMISSION,
Engr: Review
cc W
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
C6 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr• Inspection
*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
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 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 # lj
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- CALLBuilding Official or his/her Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE L OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in spare provided.
WOR N'S COMPEURANCE AND RCW 15:27. C !C S SIGNATU ) DATE
51 44 URE (OWNER ): tt DATE SIGNED (425) /� 1
' 146—: 771w0220 E BY / DA E /
ENTION 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- O 1 INAL - FILE UYEOW- INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 I IRC110. K -OWNERD - ASSESSOR
,Sr91 PRESS HARD - YOU ARE MAKING 4 COPIES
J ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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BY
VARIANCE OR CU SHORELINE OR ADB# INSPREQ'ECTION SEPA LL
�"(j D COMPLETED EXEMPT
�,/�MA/VL� ' " S— 113YES N NO
CA# ZONE SIGN AREA HEIGHT
WAIVER O ALLOWED PROPOS 0 ALLOWED PROPOSED
STUDY O „' , I t 1 '�'Q I�
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE . REAR
2
PARKING LOTAREA PLANNING REVIEWED BY ` DATE c
REQ'D PROVIDED
FT.) , REMARKS
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RECEIVED
- JUL JL 4 2005
PERMIT COUNTER
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