20050617.pdft DATE RECEIVED I
CITY OF. EDMONDS
F
STRUCTION PERMIT APPLICATION
/NAME O BUSINESS
RESS
ZIP T LEPHONE
NAME(': >ck `LL + l
ADDRESS
11 CITY ZIP TELE_PHON
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LTELJCENS=NUMBER EXPIR TIO
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1-.11 PROPERTY TAX ACCOUNT PARCEL NO. ... �\
=m I - OW
TE I CHECKED BY
C& RESIDENTIAL K.PLUMBING / MECH
❑ COMMERCIAL COMPLIANCE OR
❑ ADDITION
MIXED USE ❑ CHANGE OF USE
❑
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ClGRADING ❑ FENCE X
REPAIR CYDS (
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE ❑ CARPORT ❑ RETAINING ROCKERY WALL FIRE ❑ FIREA ARM LER
[PERMIT EXPIRES L Z v QU
PERMIT
NUMBER
JOB (� f SUIUITEEIAAPT#/
ADDRESS �T I [i ` c�lU
PAT NAMEISUBDIVISION NO. LOT NO LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Required ❑
EXISTING _ PROPOSED inspection Required ❑
S"IeWalk R"ur6d ❑
Underground ❑
REQUIRED DEDICATION FT _. Wein re wind ❑
h1ETER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NOM z
tit
REMARKS m
OWNER/CONT.RACTOA.REBPONOtBtE4PAIi L4Cf9 Z
ENGINEERING REVIEWED BY
DATE
03.2
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FIRE REVIEWED BY `'"' "'"DATE
OBSERVED BY CITY INSPECTOR LL
VARIANCE OR CL' # nftLyffn I SEPA
BEjr '� NO COMPLETED EXEMPT
CAN ZONE SIGN AREA HEIGHT
WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13
LOTS9XagAt;E• *„ 'REpL g K PROPOSEl7SETBACKS(FT.)
ALLO ED PROPOSED FRONT . SIU EAR F ONT R SIDE REAR
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P413 E �;° _ 4rOT AREA ' •'�'L � " Y DATE a
REQ,D OVIDED
FT.) REMARKS
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
tY � n &4 ke ` t�� TYPE OF ST UCTI GROUP NT
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C NUMBER NUMBER OF
OF DWELLING�} � ;Uyl;
SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES UNITS
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REQUIRED E3 YES
DESCRIBE WORK TO BE OONE
REMARKS i
rn /'/nMn Y o
1 C GEOTECH REPORT m
` W ` BY:
{I(` STRUCTURAL DESIGN
BY:
�—�(� ►1 C — ti VALUATION
$
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,11 , 03 '� 1� Description FEE Description FEE
e, I 1 (\%., Plan Check State Surcharge
H SQuFj�E. OT SL PE VESTED DATE
w� Building Permit City Surcharge
PLAN qHECK NO: Plumbing Base Fee "
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
M DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
m PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engf. Review
W
Lu
IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Eflgf. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i 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.' ,r
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, 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 receipt is acknowledged in ace provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION p 0 p
WORKMEN'S COMPENSATI SURANCE AND RCW 18:27, OFFICIALS SIGNATURE DATE
SIONATU LO E OR 0 T): DATE 7N.
ED .� (425)
� 771 0220f2Tatam.
ATE
ATTENTION EXT. 1333
ITIS UNLAWFUL T USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI• QR NAL . FIL Y LOW • INSP CTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC1108P IK • OWNE • G LD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIE