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20050687.pdfDATE RECEIVED r` y r,Y CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS MAILING ADDRESS Z2q All 6 CITY ZIP TELEPHONE EDrrrna M o:5 J )X141 -25#w ­&7Z60701 NAME ADDRESS ZIP (`�I`'✓ PERMIT EXPIRES !/ / PERMIT /) NUMBER _�//�� JOB SUITEIAPT# ADDRESS PIAT NAMEISUBDIVISION NO, LOT NO LID NO LID FEE 5 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppruved O RW Permit Requited C3 EXISTING PROPOSEDStreet use Permit Required E3 Inspection Required E3 Sidewalk Requited 0 REQUIRED DEDICATION FT Underground O -- Wem ro uenu CI METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES O NO O Z cc w REMARKS W OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE X ,rr Zoll T I.7 7 G "R}CT ( I 1 V •" ENGINEERING REVIEWED BY DATE ADDRESS MON 3 (001"Ilij FIRE REVIEWED BY DATE CITY ZIP TELEPHONE L YNNw 01519 957337 q2- 775 -� �F�� LL STATE LICENSE NUMBER EXPIRATION DATE C ECKE Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA n�A1� i I c) Ljtj I jI� r i�iO� / r l .0 YES 13NO COMPLETED EXEMPT PROPERTY TAX ACCOUNT PARCEL NO. l [[[�� CA# ZONE SIGN AREA HEIGHT WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED STUDY O ❑ NEW ❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED. FRONT SIDE REAR FRONT L/R SIDE REAR COMMERCIAL COMPLIANCE OR ? ❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE i ❑ REMODEL ❑ ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE a MULTIFAMILY SIGN REQ'D PROVIDED GRADING FENCE ❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER ❑ CARPORT ❑ ROCKERY WALL ❑ FIRE ALARM SPRINKLER (TYPE OF USE, BUSINESS OR IVIT ) �� EX IN: � WIN (/ TYPE N TRUCTIO E OCCUPANT GROUP I NUMBER NUMBER OF OF IDWELLING I SPECIAL INSPECTION CONSULTANT OeCL STORIES ' UNITS 1 V LOAD DESCRIBE WORK TO BE DONE REQUIRED YES REMARKS t 61161 z Cp INSPECTOR "/q O O� Alraw O NOT. � BY: e m STRUCTURAL DESIGN. BY: ACCEPTED lye VALUATION $ arm Description FEE Description FEE Plan Check Stale Surcharge HEAT S URCE LOTSLOPEVESTED DATE .Building Permit City Surcharge PLAN CHECK NO: 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 f DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading SEPARATE PERMISSION. Lu PERMIT,APPLICATION: SEE ECDC 19.00,005(A)(5) Engr. Review a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION V) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit ud IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF z EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY = FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE r 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 BeFReceipt # ��✓f�� IH EREBY 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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC•This application Is not a permit unlit Signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSAT190 INSURANCE AND RCW 18:27, 1. OFF� I L�G AjUR j DATE SI: RE (OWNER OR DATE SIGNED (425) �! /� - 41Irooli771 0220 REL ASED BYV ! DATE ATTE ION 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- FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110. ORIGINAL -FILE YELLOW -INSPECTOR PINK -OWNER •GOLD •ASSESSOR 101" PRESS HARD as YOU ARE MAKING 4 COPIES Z r 0 n m c Irn ma www!O On M Z DANEWZ CD wn mm i 00 C nm C CD C Cn Z� I � D (. t Z i _ Z O n m