20050752.pdfDATE RECEIVED
A </„! �- PERMIT EXPIRES �/ ,
il - :1/125:
F PE
CITY OF 9DIVIONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# 1
OWNER NAMEINAME OF BUSINESS ADDRESS 3
IPLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
W MAILING ADDRESS LID FEE 5
r/�N/ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
O C �56: RW Permit Required 0
Street Use Permit Required I'
CITY ZIP TELEPHONE EXISTING _ PROPOSED _ inspection Requited 0
'• _ �C - REQUIRED DEDICATION FT Sitlewaik RequiredUnderground
O
(I6z
Wirmil required d
NAME METER SIZE LINE SIZE NO. OF FIXTURES1 PRV REQUIRED
f YES O NO O =
U �
t ADDRESS REMARKS w
w
czi OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
z z
a w
CITY ZIP TELEPHONE
NAME CBL#
��� N {'• .i lO ' �-F-� ENGINEERING REVIEWED BY GATE
M ADDRESS
1-7 Sas ��s
¢� FIRE REVIEWED BY DATE iY
Z CITY ZIP TELEPHONE
ou D"' ,/4 � /0L;d 6) 32,1
STATE LICENSE NUMBEREXPIRATION DATE EC Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
�dWpR�C-Z'980� REQ'D COMPLETED I E%Eh1PT
OYES ONO
j FOR �YTA ACCOU T ARCE N
O CA# ZONE SIGN AREA HEIGHT
� WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
LU
�� i STUDY O
❑ NEW ❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIAL COMPLIANCE OR z
❑ ADDITION❑ MIXED USE C CHANGE OF USE Z
REMODEL ❑ SIGN REQ'D PARKING. LOT AREA PLANNING REVIEWED BY DATE g
MULTIFAMILY ❑ PROVIDED
❑GRADING ❑ FENCE X FT.) REMARKS
REPAIR ElCYDS
1:1DEMOLISH ElTANK ElOTHER
Z 1:1GARAGE RETAINING WALL ❑FIRE LER j
CARPORT ❑ ROCKERY FIRE ALARM
I a (TYPE OF USE, BUSINESS QR ACTIVITY) EXPLAIN:
TYP N TRU TIO C E GROUPANT
L)
w NUMBER NUMBER OF
OF DWELLING SPECIAL I S CTIO CONSULTANT OCCUPANT
p STORIES UNITS LOAD
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS z
0
�LPi,� GL lc ash iL% �� GEOTECH REPORT m
BY:
z> 44x GLc / ) IL STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE7 LOT SLOPE% VESTED 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
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION,
Engr. Review
ul PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr.' Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
S 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 ._
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 ORD
=INANCE PROVISION.'
Recording Fee Receipt At 01i
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 This application is not a permit until signed by the
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees 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 is acknowledged m space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. FI LS SIGNATURE DATE
S U OWNER AGE T): DATE SIGNED. (425)
..L 771 -0220 FLEAS D Y DATE
TTE N 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 1 IBC110 1 IRC110. PINK -OWNER • GOLD •ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
m
C
m�
O
On
_M
mZ
p
�
C
z
r=
J
fill