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20050605.pdfa 110i i�'.. DATE RECEIVED 1 /' PERMIT EXPIRES .2 04/or PERMIT i; 7z - ,; e _ CITY OF EDMONDS NUMBERc-: -Q CONSTRUCTION PERMIT APPLICATION JOB SUI E PT# ADDRES ,t% ,/ j• OWNER NAME/NAME –O�BUTESS F BUESS J HA I r` PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. W MAILING ADDRESS LID FEE S 7E�( P Z �"� / j (/Lr� �G� . `.L. ( PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit ❑ `� / Street Use Permit Required ❑ CITY ZIP TELEPHONE EXISTING_ PROPOSED _ Inspection Required [3�- / - )t •/{! Sidewalk Required ❑ /�. t';- l I) -)q Undorgmund ❑ JN / p LJ REQUIRED DEDICATION FT wnm r uued ❑ NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED f. YES O NCO _ W K W W ADDRESSREMARKS W UOWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z Q w CITY ZIP TELEPHONE NAME I CRL4 � ` r' I C ` U� / ENGINEERING REVIEWED BY DATE ADDRESS, (� wy (3 CITY 21P TELEPHONE FIRE REVIEWED BY DATE W s 1) W'o oct) cp�. 1(12� STAT LICENSE NUMBER EXPIR 10 DATE C KE BY ARIANC R CU SHORELINE OR' Bq INSPECTION SEPA y , i r� 'j / , f ^I /�,� REO'D COMPLETED EXE T T G " 1 L I 7 l3 C Jj Y, A)DO (� 0 0 DD': ' O YES NO a PROPER T ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT WAIVER O co`'' y�eG ALLOWED PROPOSE ALLOWED PROPOSED — D STUDY O �- qq IP Ila .,' told IrTt' r a' . ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR COMMERCIAL COMPLIANCE ORN = ❑ ADDITION ❑ CHANGE OF USE / /U N / L i ❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g 13REMODEL ❑ MULTIFAMILY SIGN R0000 EO'DP, r /DED L /� O�I'�5 1:1REPAIR ❑ GRADING ❑ FENCE IV CYDS (. X FTJ R MARKS 1:1DEMOLISH ❑ TA14K OTHER GARAGE. RETAINING WALL FIRE SPRINKLER O" g V r Z ❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM H, ii /�•'^ r� /1 1 P (TYPE OF USE, BUSINESS OR TIVITY) E IN: V 1� 1 �A , 1 l U 41 1 wlr' TYPE�COf1STRUCTI N COD �F OCCUPANT G`l //[��(,r GROUP At GNUMBER NUMBER OF r OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT p STORIES UNITS LOAD - REQUIRED O YES . DESCRIBE WORK TO BE DONE REMARKS z GEOTECH REPORT m BY: ti. STRUCTURAL DESIGN BY: VALUATION Description FEEDescription FEE Plan Check •""' .State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit City Surcharge PLAN CHECK NO: _ .1 Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanICBI BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin 7 DONMAIN (CURBS, SIDEWALKS,' DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g i SEPARATE PERMISSION, I Engr.. Review W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) IL 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 M 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 # r 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 TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Buildingreceipt official or his/her Deputy: and Foos are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION r©ceipl is :acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, F LS SIGN RE DATE 11 SIGNATURE (OWNE R GENT)r DATE I NED (425) - //.' 771 -0220 RE Y / DATE 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- ORIGINAL -FILE YELLOW I SPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC1106 PINK -OWNER • GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES . Z 0 0 M cM M 0 O0 _ M M Z . C Z r = 0 mn M 0� 0 M M :110i r 011111D Z N Z O n 1 171 i.