20050715.pdfDATA E RECEIVED�!
i7�lUrLw��i PERMIT EXPIRES l C
CITY OF EDMONDS NUMBER �CZ,>- rr> I
CONSTRUCTION PERMIT APPLICATION JOB 'I ut^ Co. SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS ZZo z J 4)
PLAT NAME/SUBDIVISION NO.LOT NO. LID NO.
MAILIN DRESS LID FEE $
` µ` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
I Z \ �ti �'— RW Permit Required ❑ .
Street Usti Permit Required ❑
CITYZIP TELEPHONE EXISTING PROPOSED _ _ Inspection Required ❑ E3 r Sidewalk Required
P �iZs` / 1 0Z-s� REQUIRED DEDICATION FT _ Underground [3Wirinrequired ❑
NAME METER SIZE 7E SIZE NO, OF FIXTURES PRV REQUIRED
r,
F YES C NO C] Z
w
t ADDRESS REMARKS w
= OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE _
iU 33
z
Lu
CITY ZIP TELEPHONE
NAME CBL#�
hor ENGINEERING REVIEWED BY DATE
ADDRESS
Q1�0 qw g
FIRE REVIEWED BY DATE w I '
CITY ZIP TELEPHONE LL Z
c Y � �i
STATE LICENSE NUMBER EXPIRATION DATEMY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA n
`LI REO'D COMPLETED E%Ek1PT M
0 r7 11 I 1 `1 .1 L C] YES 0 NO
PROPERTY TAX ACCOUN P CF�LNO. CA# ZONE SIGN AREA HEIGHT rT1
Q i 336;
•� WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
9.{ G - GG'.� U ��J'iV STUDY 13 0 _
vm
RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) C
❑ NEW ❑ ❑ PLUMBING / MECH 0
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0 rn O
COMMERCIAL COMPLIANCE OR O".(7
❑ ADDITION ❑ CHANGE OF USE z C
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g -"I
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED a M
M
Z
REPAIR
❑ GRADING ❑ FENCE CYDS ( X FT.) REMARKS C: z
C Z
❑ DEMOLISH ❑ TANK ❑ OTHER r =
RETAININGGARAGE FIRE LER
_ ❑ CARPORT" ❑ RO KERY WALL ❑ FIREALARM N
mn
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: O
06 L TYPE OF CONSTRUCTION CODE OCCUPANT
U J.—e(llOt` .�L�,U, Cl°.�7 C F i7 •7, GROUP _ !
GNUM UMBER OF l/ M M
OF �f DWELLING �f�� SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES // 'UNITS V - LOAD O (p
-i REQUIRED CI YES
DESCRIBE WORK TO BE DONE n M
REMARKSz C in
�c lack. SGS«.{- Jock 1 M O
dO�CS
GE9J9CH REPORT m t Z r
B
CAZ06%n-eS a1nN/ ei O ST°I"iDni ^.cSIGN
BY
C�00 t�'e w VALUATION 2
-tom $ S01c ,
Description FEE Description FEE I _
Cn
Plan Check State Surcharge ( ZO
HEAT SOURCE LOT SLOPE% VESTED DATE =1
Building Permit City Surcharge 0
PLAN CHECK NO: MPlumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanICBI
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Gradin
7 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION, Engr. R@VIEW
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
4 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) , Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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
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 hasp. Total Amt. Due /
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
Recording Fee Receipt # ?
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN 1S CORRECT; AND THAT 1 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• CALLBuilding Official or his/her Deputy and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt s acknowledged in space provided.
WORKMEN'S CG NSATION INSURANCE AND RCW 18:27, Cl IG RE DATE
NER� a DATE SIGNED (425)SIGNATURE , 0� yl L
J
771 =0220 REI-11A-SfD BY DAT
A ION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGIAL - F _E YELLOW - INSP CTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110• PINK ER GOLD ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM