20050761.pdf1
DATE RECEIVED ~
�/%4/ Ile PERMIT EXPIRES!
RMIT
CITY OF EDMONDS NUMBER ; L -19
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAMEINAME OF BUSINESS � I �l!�??')') fC�.] (�11
514 PIAT NAMEISUBDIVISION NO. LOT NO., LID NO.
wiY MAILING ADDRESS LID FEE 5
3❑
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved
RW PermitRequired E3/
O Street Use Permit Required ❑
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required [3? 41 --~— . Sidewalk Required 11REQUIRED DEDICATION FT Underground ❑
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--.Wiring mquited ❑
NAME METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
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YES 0 NOE3 z
UK
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t ADDRESS REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE �7
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CITY ZIP TELEPHONE
NAME jCBL#
L 1C�1 �U ENGINEERING REVIEWED BY DATE
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9 I w FIRE REVIEWED BY DATE w
z CITY ZIP fELEPHONE tel^ �^ J Cr
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STATE LICENSE NUMBER EXPIRATION DATE, CK BY VARIANCE OR CU SHORELINE OR ADEN, INSPECTION SEPA
REQ'D COMPLETED EXEMPT
P? 1Qfj VL9 1Z' w U� O YES NO
CA# ZONE SIGN AREA HEIGHT
aj_ PROPERTYT C OUNT PARCEL NO.
O `�.WAIVER i1 ALLOWED PROPOSED. ALLOWED PROPOSED
� 7 001) V STUDY E3
❑ NEW ❑ RESIDENTIAL1:1PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR c7
COMMERCIAL COMPLIANCE OR _
❑ ADDITION F1CHANGE OF USE Z
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY' ❑ SIGN REt7D PROVIDED
GFENCE —
❑ REPAIR El GRADING CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑, TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z ❑ CARPORT ❑ ROCKERY F!1l4�ii
a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
F NS CODE. GROUOCCUPANT
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NUMBER NUMBER OF
OF DWELLING SPECIAL INSP ON CONSULTANT OCCUPANT
UNITS � A 6r_ LOADp STORIES
REQUIRED DYES
DESCRIBE WORK TO BE DONE r
CUREMARKS
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on rs GEOTECH RE ORT � '�
BY: &E27) JA
ormC, a Q L STRUCTURAL DESIGN
BY:
VALUATION
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Description jFE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% ""'J"'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
H 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
UI Fire Review '� Plan Chk. Deposit t� r
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS p
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONOS, WASHINGTON,.ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire InspectionItT
'� • 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 Insp. 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 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- GALL Building Official or hislher Deputy' and Fees are paid, and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged m space provided.
WORKMEN'S COMPENSA IN RANCE AND RCW 18:27. TGTURE DAT /
SIGNATURE (OWNER OR ENT DATE SIGNED (425)
.
JAA ?/�
(-L 771-0220 E .D BY I
I 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- ORIGINAL • FILE YELLOW SPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 / IRC110, PINK -OWNER GOLD A SESSOR
•104 PRESS HARD - YOU ARE MAKING 4 COPIES
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