20050758 (2).pdfDATE RECEIVED.
F�` PERMIT EXPIRESO o�
CITY OF EDMONDS
PERMIT.
CONSTRUCTION PERMIT APPLICATION nooREss /j sUIT;IA T#
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OWNERNAMEINAM[ F/OU�jSINES5e/
f L`VC - '� `..lv t S��L 7'G v PLAT NAMEISUBDIVI510N NO. LOT NO LID NO,
W MAILING ADDRESS LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP T[SCP Approved O3C/S 4CAL J S
RW Permit Required - E
Street Use Permit Required E3CITY 21P
TELEPHONE EXISTING _ PROPOSED _ Inspection Required O
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Y4�r�(/� j (_lhb C`i1 REQUIRED DEDICATION FT underground O
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NAM (1 A METER SIZE LIIJE SIZE N . OF iXTURES PRV REQUIRED
U l�/v YES NOD z
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= ADDRESS REMARKS uwr
Q �„` �� /I 1 ` • ' ! OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE W
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CITYZIP TELEPHONE
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NAME CBL##
Y `•• i/ `"'" ENGINEERING REVIEWED BY DATE
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RFIRE REVIEWED BY DATE
o CITE ZIP TELEPHONE z
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STATE LICENSE NUMBERNj,, EXPIRATION TE, CHECKED B11 VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
p n _ 1 REQ'D COMPLETED EXEMPT
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w PROPERT{ [�X AC OUNT P CEL NO.
CAN k:WV r ZONE SIGN AREA HEIGHT
Uj CJJ(//J �- / /'t WAIVER [3 ALLOWED PROPOSED ALLOWED PROPOSED
` STUDY D NA . NG
❑ NEW ESIDENTIALpLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR h ! a lv/' Z z
❑ ADDITION Q CHANGE OF USE NV 4v S Zs
❑ MIXED USE z
PARKING LOTAREA PLANNING REVIEWED BY DATE g
REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED �D
GRADING FENCE 2, `� G00
❑ REPAIR 1:1CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK OTHER
z ❑GARAGE RETAININGFIRE
CARPORT ❑ ROCKERY WALL ❑ FIRE ALARMKLER
IL (TYPE OF USE, BUSINESS OR ACT E PLAIN.
TYPE OF NSTRUCTION CODE OCCUPANT
cmr GROUP
o NUMBER NUMBER OF j
OF DWELLING / SPECIAL INSPECTION CONSULTANTOCCUPANT
STORIES
UNITS .
,l/V%Z'A' j L el.:Plw cpe-t . /1%GtizLi
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REQUIRED YES LOAD
REMARKS
GEOTECH REPORT
BY:
STRUCT L DE$IQNr rJ
BY: G L�
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
�H SOURCE LOT SLOPE% EST T , r
X71 (�G Building Permit City Surcharge
PLAN CHECK NO: _ /) / Plumbing00 Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO McChanICBI
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)
a PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
w. 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF /
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # .`
.= ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x 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.' 1
Recording Fee Receipt #
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 application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in spare provided
WORKMEN'S COMPENSATION RANCE AND RCW 18:27.
OFF LS SIGNAT E DTE
0 N R A ENT) DATE SIGNED (425)/
r
771-0220 R SE TE '
ATTENTION EXT. 1333 � 0(.
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 I IBC110 I IRC110. I INAL -FILE OLOW -INSPECTOR
K -OWNER •GOLD -ASSESSOR
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