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20050619.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS ta)8�13 mEoWtA AV -S CITY ZIP TELEPHONE i -I- c1 p y• �'— - 7� NAME M Lie) �}�Y1S /`�'%� a ZIP TELEPHONE CBL# G: L u� i l�►�1g1l 'i ADDRESS gliq CITY n SEA} I )ROPERTY TAX ACCOUNT ;1042) NEW ❑ ADDITION ❑ REMODEL ❑ REPAIR ❑ DEMOLISH GARAGE ❑ CARPORT % % s� PERMIT EXPIRES I PERMIT NUMBER. Com' CiLsi � /,✓�,�,�: rl , JOB SUITEIAPT# ADDRESS 0 �1 M e — PLAT NAME/SUBDIVISION NO, LOT NO. LID NO LID FEE 5 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PeWPe Approved O RW Required E3 Street Use Permit Required 0 EXISTING _ __ PROPOSED ^_ Inspectron Required / Sidewalk Required Q REQUIRED DEDICATION ! _ FT Underground Witing re wrod METER SIZE „ LINE SIZE NO. OF FIXTURES, PRV REQUIRED O YES O N013 ? ILI w REMARKS z OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE 3 . W BY unle '� / V FIRE REVIEWED BY DATE it ZIPTELEPHONE U. Ok/• "��C�� ���� VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA EXPIRATION rDATE EC BY /► A y� REQ'D COMPLETED EX tPT C1 f vv 0 YES 0 NO CA# ZONE SIGN AREA N / HEIGHT N 1 ARCEL NO. WAIVER n� '/Y ALLOWED - PROPOSED ALLOWED PROPOSED 00'3 �s�%� STUDY 1 LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) RESIDENTIAL ❑ PLUMBING / MECH ALLOWED PROPOSED X4*W 'S'1QE-• REAR- FRONT LIR/ SIDE REAR ❑ COMMERCIAL COMPLIANCE OR�'��I� �'(� 2S1Stf"* ID(51• eo ❑ CHANGE OF USE ✓10*1 ar z ❑ MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE / g © MULTIFAMILY ❑ SIGN R� PROVIDED N!�5� 0�I 1 GRADING FENCE '1 ❑ CYDS ❑ ( X FT.) REMARKS ❑ TANK ❑ OTHER RETAINING WALL FIRE SPRINKLER PQ ROCKERY ❑ FIRE ALARM ,� (� o f �/ q I l mUyAr Me c/t t) e p I.IL'h. )R ACTIVITY) EXPLAIN: I A ?- " t7l f d J ^PE OF CONSTI;ION CO^En GROUPAN� NUMBER NUMBER OF OF DWELLING SPECIAL INSPECTION CONSULTANT OCD OCCUPANT STORIES UNITS REQUIRED O YES DESCRIBE WORK TO BE DONE t, REMARKS �, /y% /. z U4LI ,� ! (^ n iV1 GEOTECH R ORT m BY: ` ry�rI STRUCTURAL DEF " • 1 BY: J� I�JW ANI VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit City Surcharge PLAN CHECK NO: Plumbing Base Fee Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 9 SEPARATE PERMISSION. Engr, Review 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 IN INTEREST, AGREES TO INDEMNIFY* DEFEND AND HOLD HARMLS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS ROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF T141S PER 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.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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- GALL Building Official or his/her Deputy: and Fees are paid, and EREBY, NO PERSON WILL BE EMPLOYED FOR IN receipt is acknowledged in space provided TION; AND IN DOING THE WORK AUTHORIZED TH. IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.. FI ALS SIGNA RE DATE (O Or! DATE SIGN,y ' (425) Z !/ � 771m0220 RE Y DAT 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 1 SPECT R FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110I IRC1100 PINK -OWNER GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES 9 NO2 0 41 '08 T80.03' sr m d"opdIllew � 60 Cl) ftb Ito b m m 0 I EXISTING A� PHAL T DRIVE n I �p '�OOOb �O S"� � I \ oo �i 1 CO CO Co . � Z - � m , n r'' 1rr 0 Coo rn co N) rrl ,G) z�o� , i m C "•` m It pm�� Ab c Ii N �a(:z Q ONJM �z o b =, ,, mOmr OD *A Zm m a"ll cn co ��o m m r Co001 i o� aA on0oIto = ytT it ++++"—' 00i do C4a m o n a x y Qi 1 - Za'4.:5; v�awl \� Z mm H Z °` O y o m° 0 O� r 0 ;��zo owg m m m" m �y i It 3b pj co Oro! wt o I = Co cm \ ' O C m co jo y \ I l 10,_III din 0„ \\\� I CO C rIo loo0 O \ co Z iCo 0 0� m I w y ` co � I cp r �I� n m 'm m m m ~, r M I co c y C/)Cz Z CI , m I �� 100 o awl PROPOSEDco . 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