20050626.pdfI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP
TELEPHONE
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NAME
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ADDRESS
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CITY ZIP TELEPHONE
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NAME ICBLN
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PERMIT
INUMBER
III
PERMIT EXPIRES
JOB
ADDRESS
SUITE/APT#
�71`
61
PLAT NAME/SUBDIVISION NO.
LOT NO,
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
TESCP Approved
RW Permit Required
EXISTING PROPOSED
Street Use Pennit Required
Inspection Requited
Siouwalk Required
REQUIRED DEDICATION
FT
Undefffound
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
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\-/ I I ENGINEERING REVIEWED BY DATE -
ADDRESS Ct S . FIRr, VIEW .1, ffitm 1 01/11 lws—
CITY TELEP146k DATE W
ZIP -7
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY vt RIANCE OR CUV I SHORELINE OR ADBI INSPECTION SEPA
REO'D COMPLETED I EXEMPT
13 YES 1;KO
PROPERTY TAX ACCOUNT PARCEL NO. CAN ZONE SIGN AREA HEIGHT
WAIV 2 ALLOWED PROPOSED ALLOWE
S-o Z STU 13 W-1-k _. . �14 1 kno D PROP III .
0 NEW RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.1-
PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSDE REAR
COMMERCIAL COMPLIANCE OR 0 t I I
1:1 ADDITION 0 1,0,-O� a0i 101 1 &44 01
MIXED USE CHANGE OF USE W670 % I -6q
REMODEL PARKINGVIDED LOTAREA PLANNING REVIFWFn RV IfA E'
MULTIFAMILY SIGN REO'D PRO
GRADING FENCE
REPAIR CYOS El ( _x FT.) REMARKS
DEMOLISH TANK OTHER
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR tACTIVITY) EXPLAIN
_V TYPE OF CQNSTRUCTION COD� JOCCUPANT
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NUMBER NUMBER OF 1111� I R2_
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS U LOAD4f/vV
DESCRIBE WORK TO BE DONE 1Z 241z REQUIRED OYES
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
_7ESTED
Plan Check
-760 1�
State Surcharge
HEAT SOURCE
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DATE
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Building Permit
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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
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
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
,
Recording Fee
Receipt #
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S C ,jP59RANCE AND RCW 18:27.
,,AMTSATION
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his 'hor Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
Icl SIGaRE DATE
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N ENT.
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DATE Sl
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RELEASED BY D 4E
ATTENTION r EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL /Y ( 71z
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLO/W - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAIJ PROJECT APPROVAL t ORM HB 10 -2006
TO:
DATE:--
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MEMO TO: PERMIT'COORDfNATOR, BUILDING. DIVISION
FROM: FIRE DEPARTMENT I)ATE___2L::J( �—Z)
PLEASE SIGN
ENGINEERING DIVISION DATE-
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DESCRIPTION OF WORK TO BE INSPECTED /3 L I
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denotes that there are no objections from the above signed Department. to the release of
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PERFORMANCE BONDS and.the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT. FINAL. PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
FINA,,-, PROJECT APPROVAL I JRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
PLEASESIGN
4,(/L/,ENGfNEERING DIVISION DATE A2&_
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El. Copy of CORRECTION NOTICE given to: O*wner/contractor.by inoector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tcmp:b1dg:fon-ns:ocaprv1 3/25/04
RECORD OF INSPECTIONS