20050719.pdfR"R DATE RECEIVED
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PERMIT EXPIRES J l
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS , / L SUITE/APTp
OWNER NAME/NAME OF BUSINESS /) r
n v C ,Te i [�- PLAT NAMEISUBDIVISION NO. LOT O. LID NO.
W MAILING ADDRESS 1 LID FEE S
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0 C I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
t` RW Permit Required
Street Use Permit Rnq�e
CITY ZIP TELEPHONE EXISTING PROPOSED _ Inspection Required
Sidewalk Required
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1 (� REQUIRED DEDICATION _ FT Winne au unod O
1 NAM /!— METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS REMARKS W
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z W
CITY ZIP TELEPHONE
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NAME
tj�-� e ENGINEERING REVIEWED BY DATE
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zCITY ZIP TELEPHONE F E41:ED DATE it
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY RIANCE CU FSHORELINE��OR ADB# INI PECTION SEPA 0
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PROPE TY TAX ACCOUNT PARCEL NO. CA IY ZONE SIGN AREA HEIGHT
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RESIDENTIAL' LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) _
❑ NEW ❑ PLUMBING / MECH ALLOWED PROPOSED -PRO OT-SIB_E^ REAR- F "LlI STOE v M
❑ COMMERCIAL COMPLIANCE OR N � •. =- ? C v
❑ ADDITION " ❑ = i i r ) 2 M
❑ MIXED USE CHANGE OF USE z = O
PARKING LOT AREA PLANNING REVIEWED BY DATE 5 O n
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN EQ'D PROVIDED '-/ a 0 C'
❑ REPAIR ❑ GRADING ❑ FENCE I U ',�` 1T O m m
CYDS ( X FT.) REMARKS Z
❑ DEMOLISH ❑ TANK 1:1
OTHER D Z
Z ❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREALARM
a(TYPE OF U E, USINESS OR ACTIVITY) EXPLAIN:
TYPE OF CONSTRUCTION CODE OCCUPANT
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m 'OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT 3:0 STORIES UNITS (n LOAD M ern
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DESCRIBE WORK TO BE DONE REQUIRED YES
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Description FEE Description FEE 1
Plan Check _ State Surcharge J
Cyt / HEAT SOURCE LOT SLOPEoo VESTED DATE C Z j
PLC d o 3,41 0 v Building Permit City Surcharge J O
PLAN CHECK NO: _ Plumbing ,� Base Fee n
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical -
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
� Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(8) " -
Engr• InspL
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U1 *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review % Plan Chk. Deposit
LLJ IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLO HARMLESS THE CITY OF
z EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection `� ! Receipt # l
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY J
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE _
0DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due 5 q
= NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* , I
I MRecording Fee Receipt #
-71
I 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This Official
capon is net a putt': until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Oflicial or his/her Deputy: and Fees aro 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 COMPENSATION INSURANCE AND RCW 18:27,
FF SIG )f RE . r DATE
DATE SIGNED (425) 1� /5L,45
SI TORE i10R AGEN l ` / ( �
771 -0220 R ED BY ATE
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-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 I IRC110, ORIGINAL - FILE YELLOW - INSPECOtOR
PINK • OWNER GOLD - ASSESSOR
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