20050710.pdfr DATE RECEIVED
I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
q Wa
CITY ZIP TELEPHONE!
D �� 4 - U- o1 -I of
NAME
ADDRESS
C11 �Oli1�
CITY
Sec L�
STATE LICENSE NUMBER
?x Ocmolliiiii C)
❑ NEW
❑ ADDITION
❑ REMODEL
❑
REPAIR
❑
DEMOLISH
❑GARAGE
CARPORT
(TYPE OF USE, BUSINES
7[W1194 1
ZIP
CBL#
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Cj• PERMIT EXPIRES 1 '0
PERMIT
NUMBER
JOB SUITEIAPT#
ADDRESS q%Q V Y '� .^
PLAT NAME/SUBDIVISION NO. LOT NO. Llb NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required
Street Use Permit Requited 13
EXISTING PROPOSED Inspection Required 11
Sidewalk Required E3
REQUIRED DEDICATION FT Underground O
---
Mine required. O
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
L7
YES ❑ NO 0 Z
W
W
REMARKS W
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRIUNAGE z
t7
z
W
REVIEWED BY/'; DATE
F E R EDBDATE W
ZIP • TELEPHONE w
QFSI ��� CR%4U I r
EXPIRATION DATE CHECKED BY V RIANCE OR CLf SH RELINE OR ADB# INSPECTION SEPA
REO'DTED EXEMPT
COM Liz 1 1 Z
GW l._ pe) a YES 0 NO O
CA# ZONE SIGN AREA HEIGHT
PARCEL NO.
'`
WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED n
Leco STUDY O rn
❑ LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
RESIDENTIAL
1:1PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR i
MIXED USE ❑ CHANGE OF USE zm
PARKING LOT AREA PLANNING REVIEWEC BY DATE 5 C
❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED m
❑
GRADING ❑ FENCE n
CYDS ( X FT.) REMARKS i O C
❑ TANK OTH 1 = rn
` Im Z .
❑RETAINING WALL FIRE SPRINKLER JO
. ROCKERY ❑ FIRE ALARM
OR ACTIVITY) EXFA.AIN: D Z
OCCUPANT
GROUP
G OF I DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
REQUIRED YES
DESCRIBE WORK TO BE DONE
ad
REMARKS i
GEOTECH REPORT
m
BY:
T'l• STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check �05 (� O State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit � U City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO 31
Mechanical
gBE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Grading,
J DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g.
t SEPARATE PERMISSION,
21 Engr. Review
a PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
iW 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 Fife Review s Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
X 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 BE02 51 co
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Duo
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # TM
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 pornet until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hislner Deputy: and Fees aro paid, and
TIO AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED g y' d
IN CATION OF THE L R E OF THE STATE -0F WASHINGTON RELATING TO FOR INSPECTION incept is acknowledged in space provided
WOR MEN'S COMPENSA I U NCE AND RCW 16:27. SIG URE AT
SIGNA RE (OWNER O AGE T): DATE SI ED (425) DATE f\ <
771 -0220 E SED BY 1AfE if
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL r C `_
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI• I NAL • FIL YELLOW - INSPECTOI
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 1BC110 If IRC110, 1 K .0 + GOLD - ASSESSOR
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