20050684.pdfDATE RECEIVEg '
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAAMMEE//N.A_MEE OF BUSINESS
IYI MAILINGADDRESS
W
2
ZIP TELEPHONE
gSt031 2&-ci�Lf-1
LEPHONE
?6-819
3
PERMIT EXPIRES
PERMIT �r
NUMB ER
ADDRESS �j�`/�/`� (r'•/r � JOB/SUITE-/APT
PLAT NAMEISUBDIVISION NO. LOT NO LID NO. /�-�•
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required 17
Street Use Permit Requited C3
EXISTING _ PROPOSED Inspection Required O
Sidewalk Required 0
REQUIRED DEDICATION FT Underground O
Wiring requited 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO C3 z
Uj
w
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
15W
% ENGINEERING REVIEWED BY DTE
Q
p ADDRESS' I /�'/2�Ua D ��To
.�.r" / �l� lei- , ti
FIRE REVIEWED BY DATE
z CCK ZIP TELEPHONE
c` J���l� 1.1
STATE LICENSE NUMBER EXPIRATION DATE CHF KED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
��REQ'D
COMPLETED EXEMPT
la YES O /
NO
PROPERTY TAX ACCOUNT PARCEL N0. CA# ZONE SIGN AREA HEIGHT
Ile _
OO�� OO D� WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
d STUDY El tv
f>•A NL
❑ NEW ❑ RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT' SIDE REAR FRONT, UR SIDE REAR
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑ IV& 20 15 ,o 114*/ , z
❑ MIXED USE CHANGE OF USE z
1:1 MULTIFAMILY
LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D PROVIDED a
❑ 1:1GRADING ❑ FENCE z >j
REPAIR CYDS ( X FT.) REMARKS I �iKrr
❑ DEMOLISH 1:1 TANK 13 OTHER W •
z ❑GARAGE RETAINING WALL FIRE SPRINKLER �h �'� 010,
CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
a .� 7
^ TY O ANT
CONSTRUCTION CODE GROUP
U
Lid NUMBERPP�, N MBER OF.
m OF DWELLINGSPECIAL INSPECTION CONSULTANT OCCUPANT
o STORIES UNITS O LOAD
DESCRIBE WORK TO BE DONE REQUIRED 0 YES
RAS� V�JMC � 0 {J— GEOTECH REPORT m
AS �Vr7J BY:
T
BY: SgO L .
_ VALUATION
$
Description FEE Description FEE
Plan Check `� State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge !�
PLAN CHECK NO: / L _ / Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
J
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading
r SEPARATE PERMISSION,
Engr. Review
Lu 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
N •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 HARMLESS THE CITY OF
N . EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # 04/rt ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
o 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.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• This application is riot a permit until signed by the
TION ND IN DOING TJEL WO K AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
INV ATION OF THAB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIONreceipt is acknowledged In space provided.
N'S COMPENATIO I SURANCE AND RCW 18:27.
O
FI A RE DATE
SI T E (OWNER GE ): DATEJIGNED (425)
DL 771 �022� Y JDAIE T
A TION EXT. 1333� < --
IT I UNLAWFUL TO US R OCCUPY A BUILDING OR STRUCTURE UNTIL ' t' ) J
A F AL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FIC E OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110, ORIGINAL FILE •YELL IN ECTOR
PINK -OWNER •GOLD •ASSESSOR
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Main 'JtrL'Et [orl.prdtr Office •le?o' rJtonc Way N• Seal Ur. WA 98103
Edmond, WA 9.5020(; t'1'.onr (20G) 63.1 1 35G fm (206) 63•4 !.997