20050756 (2).pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BU JESS
C��=rte,
MAILING ADDRESS
7411 ( (AW) �� � �v /,r•
CITY n^ ZIP TELEPHONE
NAME ka
PERMIT EXPIRES
PERMIT
NUMBER _-
JOB
ADDRESS •'7 U ` S 7
/APTp
PLAT NAMEISUBBDIVISION NO. LOT NO '
LID NO.
LID FEE S
PUB C RIGHT OF WAY PER OFFICIAL STREET AIAP Illlftll�nr�r�
.�^•%•'l.>• A�1') rT� r R r i RW Permit Required 1
EXI ING R001 S 11'L,ASTIZ' _f ' e ' ►'g
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RE IRPJDEDI
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M El SIZE LI�IE'SI ` 'r a'^ I
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11 L41 NT
O ER ONTRA97OR RESP91i{S1B1. FOR ERASION C j A
1, - r r IPr7N` 117
NAME _ CB `.( 1. • I dt' q..rWo
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31) EN INHERING REVIEWED BY " ` t. t f 1 jjA•m t
ADDRESS r
lr n A S L/V r' L; jaS fit„ ECTR LCA(,
CITY ZIP TELEPHONE FI REVIEWED BY DATE
77
ST ;T ICE�NSE:NUUM�BER J/// I EXPIRATION ATE CHECKS BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
1 )V. + - ` / J�/ 671 �• (D if .REVD COMPLETED EXEMPT
> (� l✓ v ` l I O Y O NO
PROPERTY TAX ACCOUNT PARCEL NO. CAH I R HEIGHT
❑ NEW
❑ ADDITION
❑ REMODEL
❑
REPAIR
❑
DEMOLISH
❑GARAGE
0
CARPORT
(TYPE OF USE, BUSINESS
NUMBER
OF
W
LL
Q. WAIVER i] AP 1+REG `�O �LLOWED PROPOSED
STUDY O HALLBL'` IN 'TALL N1�A�
RESIDENTIAL11-
UMBING / ECH LOT COVERAGE PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL CO ANCE OR
❑ CHANGE OF USE z
MIXED USE z
PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED a
❑ GRADING ❑ FENCE
CYDS' ( X FT.) REMARKS
❑ TANK WE!
❑RETAINING WALL FIRE SPRINKLER
ROCKERY ❑ FIRE ALA
RACTIVITYkEX IN: 70
`P� I X. 1 YPE(0F41NSTFUC7M gQDrmm5 OCCUPANT(
NUMBER OF J
DWELLING
STORIES UNITS SPECIAL INSPECTION CONSULTANT OCCUPANT
O
REQUIRED D YES [LOAD
DESCRIBE WORK TO BE PONE /
REMARKS
-ce
GEOTECH REPORT
Wait/ BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description FEE. Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit P City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
c
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
2 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) „y .
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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Receipt #
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.'
HAT THE IRecording Fee Receipt #
GIVEN IINFORMATON BS CORRECT; AND THAT I M THE OWNER, ORY ACKNOWLEDGE THAT I HAVE READ THIS PTHE DULY AUTHORIZED AGENTLICATION: TIOF APPLICATION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
WORKMEN'S COMPENSATIO!MURANCE AND RCW 18:27. IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is ack POedged in space provided.
SIGNATU (OWNER AGENT DATE SIGNED OFFI LS SIG R DATE
(425)
OAC�� _ Z G5 771 -0220 RELEASED B 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 I IRC110. o GI AL -FILE YELLOW -INSPECTOR
P -OWNER • GOLD •ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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RE-INSPECTED OUTSTANDING ISSUES. - GRANT FINAL PROJECT APPROVAL