20050692 (2).pdfi
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DATE RECEIVED •�-- r/vJ ��
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER--���
CONSTRUCTION PERMIT APPLICATIONJOB; SUITE,AP
OWNER NAMEINAM USINESS ADDRESS � `
' C PLAT NAME/SUBDIVISION NO. LOT NO. G LID NO,
MAILING ADDRESS LID FEE $
CJ l ♦ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
r L. G RW Perms Requital 17
Street Use Permit Required 17
CITY _ ZIP TELEPHONE EXISTING PROPOSED Inspection Required O
Sidewalk Required 13
REQUIRED DEDICATION FT Underground O
--I Wiling required. E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES O NO13 Z_
r w
REMARKS w
OWNER
/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE _
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ENGINEERING REVIEWED BY DATE
ADDRESS r�
FIRE REVIEWED BY DATE w
CITY ZIP TELEPHONE
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C* 95/x3 2,�e G 3�y-23b
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STATE LICENSE NUMBER EXPIRATION DAT CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SE
f r� n, /J REO'D COMPLETED EXEMPT
/ ' L 1L0 d- � U11�. 2010S 13YES ONO
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
00 S 6i, SSG 00 ro 0 3 00 STUDY O
❑ NEW RESIDENTIAL UMBING I ECF1 LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS AR
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
1:1COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE PARKING
❑GRADING LOT AREA PLANNING REVIEWED BY DATE g
MULTIFAMILY ❑ SIGN REQ'D PROVIDED
FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH 1:1TANK ElOTHER
❑GARAGE RETAINING FIRE
CARPORT 1:1ROCKERY WALL ElFIREALARM SPRINKLER
(TYPE OFJASE SI ESS OR ACTIVITY) EXPLAIN:
J` TYPEOF CONSTRUCTI N COGDJ `�— OCCUPANT
/� / / GROUP.
NUMBER NUMBER OF //
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS v LOAD
REQUIRED � YES
DESCRIBE WORK TO BE DONE
REMARKS z
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A. trin w Lr J •'s•� GEOTECH REPORT m
BY:-
STRUCTURAL
YrSTRUCTURAL DESIGN
BY:
VALUAmNN f/
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Description FEE Description FEE
Plan Check Slate. Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit ;;.,' City Surcharge Z
PLAN CHECK NO:Plumbing Base Fee. 1200
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO MBChanICBI
- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review .
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
*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
r EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,$
=
Recording Fee Receipt # Q
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or Nsihor Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged n space provided.
WORKMEN'S COMPEN ION NCE AND RCW 18:27. OFFICIAL URE DATE
SIGNATURE (OWN O ENT • DATE SIGNED (425)
os�o b irU * 771-0220 7E"LEASA16Y `J DATE
ATTENTION 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- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK -OWNER GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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