20050651.pdf0
CITY
NAME
CITY
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
E_RiNAME/NAME OF BUSINF:Stsf I
Ut_b6_ Avf- W
ZIP- TELEPHONE
TAX ACCOUNT PARCEL
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
NUMBER
OF
STORIES
II HEATISOURCE
I PLAN CHECK NO:
CBL#
PERMIT
NUMBER
JOB
FLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METE&SIIE� mme size— —reltlltr. UREIC
.0 eq�
co tiectors r ju
Type 11 o?' J*L - ellit cO
F 114
m4kRal-Ourning apl) '
ENGINEERING REVIEWED BY
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
13
RW Pernul Required
0
Street Use Ptinnit Required
13
Inspection Required
0
Sidewalk Required
13
Underground
E3
Wiring required
13
_P
;dIE P V REQUIRED
YESIV NO CI
E
. M _ I FIRE REVIE ED BY
TELEPHONE presstire/rellef valveo an appromeu
Yft2k 111!�.%�A ..rii(Andon tan shall be
EXPIRATION DATP cH A174F-D 13Y VARIANCIUR-66' 0ORELINICWtIl on
instal 0 On 0 COMPLETEIPAEXEMPT
tz�Nir�� V , �n ' ' C
okl� K t9NE3 NIT
Lj
COMMERCIAL
1:1
MIXED USE
El
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
NUMBER OF
DWELLING
UNITS
��BING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( — x FT.)
OTHER
FIRE SPRINKLER
FIREALARM
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.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Uj
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U)
fA -APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
UJI
_j IN INTERE3T. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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.,
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�MPEN ?��NCE AND RCW 18:27.
SIG ATUR to IN.�R-&*<G�NT),/ DATE SIINEDJ,,
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CAN ZONE
WAIVER 13 ALLOWED ROPOSED ALLOWED I PROPOSED
STUDY 13 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ'O . PROVIDED 1z
REMARKS
TYPE OF
SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recordina Fee
CONSULTANT
FEE
'(�)o
CALL
FOR INSPECTION
(425)
771-0220 —RE
ATTENTION / ,,/ EXT. 1333
IT IS UNLAWFUL TO USIfOR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 f IRC110.
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
a
FEE
10C
- CFC-)
Plan Chk. Deposit
Receipt #
Total Amt. Due
1 Receipt #
APPLICATION APPROVAC
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
N?Sl TURE 'UA DATE
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10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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