20050661.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
uj MAILINGADDRESS
C, A OoL
CITY ZIP TELEPHONE
9707, 4j6-'jC-j I C)
--------------
ADDRESS
ADDRESS
CITY
ZIP
E
TELEPHONE
ICBLN
7 1 1 PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS ?0
PLAT NAME/SUBDIVISION NO.
LOT NO
LID NO,
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appr 1 13
RW Permit Recuirud
Street Use Permit Required
EXISTING PROPOSED
Inspection Required
Sidowalk Required
REQUIRED DEDICATION FT
Underitiound E3
I
Witino rwiu-frid
METER SIZE
LINE SIZE
NO. OF FIXTURTPRV
R QUIRED
9 [3 NoM
YE,
9
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
111MA11:11111
DATE
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
VARIANCE OR CU
SHORELINE RADB#
I INSPEC�ION
REQ D
13YES ONOI
SEPA
COMPLETE
CA#
WAIVER 13
STUDY 13
ZONE
SIGN AREA
ALLOWED I PROPOSED I
HE IGHIT
ALLOWE 0 PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
0 -57-�� 06Z?
L
NEW RESIDENTIAL
ADDITION COMMERCIAL
MIXED USE
kREMODEL MULTIFAMILY
kp LUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
LOT COVERAGE
ALLOWED PROPOSED
I
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED ETBACKS (FT.)
FRONT URSIDE REAR
I
PARKING
REO'D PROVIDED
LOTARE
ING REVIEWED BY DATE
GRADING
REPAIR El CYDS
FENCE
x FT.)
I
REMARKS
DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
TYPE OF(�ST&TION
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GROUP
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTI07N
REQUIRED 3
CONSULTANT
OCCUPANT
LOAD
1
DESCRIBE WORK TO BE DONE
FEE Description
6 j State Surcharge
2— —
'VA
City Surcharge_
Base Fee
rW1
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due j W
1 Receipt #
APPLICATION APPROVAL
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.
E�jic" SIGNATUR C)ATE
SIGNA06 E(bW "IRO 11 N DATE IGNED (425)
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ATTtNTION f EXT. 1333
ITISUNLAWFULTOUSEOROCCUPYA BUILDING OR STRUCTURE UNTIL —Y
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
RIGINAL - F E YELLOW -INSPECTOR
PI O�
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110. Y"�*FPINK - OW E GOLD - ASSESSOR
110104 PRESS HARD - YOU ARE MAKING 4 COPI
REMARKS
GEOTECH REPORT
BY:
614P�attC-
STRUCTURAL DESIGN
BY:
'VALUATION
o
Description
WKPlan
Check
HEAT SOUfiCE LOTSLOPE%.
(�q,4
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
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
Fire Inspection
Landscapeinsp.
iRecording Fee
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- CALL
TION: AND IN DOING THE WORK AUT14ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLP FOR INSPECTION
,,rpN OF THE LABORJOODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEWS COMPENSATIONOSURANCE AND RCW 18:27. 1
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N OTI I CE: IFT I HE DOCUMENTIN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
214th Place Southwest
Edge of pavement
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-N 90" 0'0" S 93 9.000'
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PAGE
Arta of Scale: 1 in 20ft.
NORTH
proposed Oin.
Garage remodel-
FF-1
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEALSE SIGN
ENGINEERING DIVISION DATE -Z,-
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the grantin g of
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GRANT FINAL PROJECT APPROVAL
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-GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to o.wner/contractor by inspector
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FAILED FINAL INSPECTION OUTSTANDING ISSUES
n Copy,of CORRECTION NOTICE given to owner/contractor by inpe.ctor.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINALTROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04,