20050614.pdf.-..r—
DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT R
CONSTRUCTION PERMIT APPLICATION JOB 9UITEIAPT#
ADDRESS
OWNER NAMEINAME OF BUSINESS �� ' • I C }- i
PLAT NAMEISU13DIVISION NO. LOT NO. LID NO.
MAILING ADDRESS 1` I LID FEE b
1 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 1ESCPnpprovod O
/ 6 RW Permit Required 0
Street Use Permd Requited 0
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required I7
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JG/j ^— Sidewalk Required 0
7 / / L7 4 REQUIRED DEDICATION FT Un,,n, r O
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NAME METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
YES D NO D z
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ADDRESS REMARKS i
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NAME /,� ' ! CBBLL#
! I Q/f� I ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE w
CITY ZIP TELEPHONE x
LL
STATE LICENSE NUMBER EXPIRATION DATE ECKED Y VARIANCE OR CU SHOREELINE ORADDB# INSPECTION SEPA
RE
'p ' �D ✓�O 1 D YESQONO,
COMPLETED EXEMPT
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PROPERTY TAX ACCOUNT//P''A`R�CELyNO. CA# 04 � I bZ ZONE SIGN AREA HEIGHT
ilf)o `� I O� STUDYWAIVER D P ALLOWED PROPOSED ALLOWED PROPOSED
❑ NEW ❑ RESIDENTIALMBI ! MY ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR.SIDE REAR
COMMERCIAL COMPLIAN EOR z
❑ ADDITION ❑ `l i ��
MIXED USE CHANGE OF USE i
® REMODEL OS PARKING LOTAREA PLANNING REVIEWED BY DATE CL
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1:1 MULTIFAMILY ❑ SIGN REO . PRD r D-71�/
❑13GRADING ❑ FENCE. X FT.) REMARKS / `
REPAIR CYDS
❑ DEMOLISH ❑ TANK ❑ OTHER
❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
/; `,�U L� ____"TA
TYPE OF TRU TIO CODE OCCUPANT
lr ! GROUP
NUMBER NUMBER OF
OF DWELLING 1 SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS 1 _ LOAD
jj ? /- REQUIRED YES
/0� /WORK TO
ALL BE E I► i� �U L� (.T/ + ?f1(� ! REMARKS D _
GEOTErk REPORT
r . e BY:.67L m
/ Q. 1 N •9 YES I> STRUCTURAL DESIGN
^ BY:
C 9 U ` T O� � ) VALUATION
exlru�► s �t� . $
_ t,, Description FEE Description FEE
_ Plan Check State Surcharge
HEAT SOURCE LOTS OP % VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO:
t,.._`C:�Q Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical r_=7
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
i DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00,005(A)(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
ji IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
IF 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 �J
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' a .
Recording Fee Receipt #
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, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building receipt
i or his/her Deputy. and Fees are paid, and
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 5ew 18:27,
OFFICIALS SSI-G�NATURE _ DATE
SIG R )4, DATE SIGNED (425) IV 440. 4— \ ^
'i Y ,
771-0220 RELEASED BYTE
ATTENTIO EXT. 1333 I', Z6 S
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- o IGI AL -FILE Y LLO INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110I IRC110. PIN -OWNER OLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES '
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