20050594.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
/14*1/— F��
MAILING ADDRESS
2-0 ( gt�Aur- -5
CITY ZIP TELEPHONE
qiyazo - OZ, -3
I W-5
NAME
6 livoj, e, r-.
4
CITY
STATE LIeENSE N
TELEPHONE
PROPERTY TAX ACCOUNT PARCEL NO..
0 NEW
RESIDENTIAL
0 ADDITION
COMMERCIAL
MIXED USE
MULTIFAMILY
El REPAIR
GRADING CYOS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACT�VITY) EXPL�AIN
CBL#
PERMIT EXPIRES
PERMIT
NUMBER 051
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
I
LID NO�
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
C3
RW Permit Required
Street Use Permit Required E3
EXISTING PROPOSED
inspection Required E3
rl
Sidewalk Required [3
REQUIRED DEDICATION FT
UndDirgiround 0
I
— —
Wirinq roquired 5_
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO13
z
REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
E5
z
tu
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE uj
1ION DATE CHECKED BY VARIANCE OR CU SHORELINE ORADB$J1 I INSPECTION SEPA
REQ'D COMPLETED I EXE41PT
A-d -4'pp C1 YES 0 Nol A
S.!!Lj - F-OEaq ZONE SIGN AREA I HEIGHT
WAIVER N P� 6/ ALLOWED PROPOSED ALLOWED PROPOPEC
STUDY [3 1 Lo 10_0� I 10� 1 -7,-51 1 W IL
PLUMBING 1 MECH LOT COVERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE PEAR FROtIT URSIDE REAR
C COMPLIANCE OR 51Y VtR�
CHANGE OF USE 5 24 0/1.
PARKING
'ON D
P
0 El SIGN REQ*D I PROVIDED I LOT AREA PLANNING REVIEWED BY DATE
FENCE
!E
X FT.) REMARKS
0 T H E R"k��— Slip, nw sa
FIRE SPRINKLER
FIRE ALARM UM 6i"1II"IIA "td ---;Y Wf i'l nA)� I A C -ffi(3+:D 0
LL�2��% C_�,A
TYPE OF CONSTRUCTION
Deth—L
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTION
REQUIRED OYES
DESCRIBE WORK TO BE DONE
REMARKS
eg c e- AA7 eA-t_t_ a4- -ey,,�s 4
GEOTECH REPORT
BY:
-.00,
STRU��q LTG�L
BY:
VALuA:riON
$
Q —to RMP
fjo
Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
C)s — cp, piq
Plumbing
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
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CODE OCCUPANT
0) GROUP.
CONSULTANT
THEOWNER. I AGREE TO COMPLY WITH CITY AND SIAIE LAWS REGULAIING Wnallxv
C
Z 'D DING T CALL
FOR IN
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
[IN VI ' DILATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPEXSATION INSURANCE AND RCW 18:27.
S I
IGNA 0 OR AGENT): DATE SIGPED (425)
771-0220
ATTENTION 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.
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110.
FEE
Description
State Surcharge
City Surcharge
Base Fee
FEE
MP
PlanChk.Deposit /q/./V-,
LA.-10
Receipt #
Total Amt. Due h
1 Receipt # lg&
zu
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
110104 PRESS HARD - YOU ARE MAKING 4 COPIE
91
-IYL:LLUVV -INSPFC]IL
iW*R -1 GOLD - ASSESSOR
z
0
4
0
M
--I -n
M
C
M
0
-10
0 C
--I ic
X M
M z
IC) -11
C _z
o -n
n
M M
a
0
0 M
C cl)
9 co
Q 0
Z
z
--I
x
CD
z
0
i
0
ITI