20050761A.pdfDATE RECEIVEDF* —"
PERMIT EXPIRES ! 7-
CITY OF EDMONDS NUMBIER�:'-' 7Cc?/
CONSTRUCTION PERMIT APPLICATION JOB sutTEIAPT#
ADDRESS �7 -'�7 1 �/1 r I
OWNE AMEINAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO. LOT NO LID 00
ut MAI GADO SS Y L' / LID FEE S
a j � C. � /�i W� j� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW
mil Required
O
/ ./ �/ YY �N /,I / TF Permnoaved O
Steel Use Penna Required 13
CITY
gZIIP��TELEPHONE EXISTING PROPOSED InspeclronRequndd O
Sidewalk Required 0
REQUIRED DEDICATION FT-- ndorgi" "d J
Wrcm ca0 required 0
NAME / METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES13 NO O
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1= ADDRESS REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE W
CITY ZIP ITELEPHONE
77/p e6 46
NAME CBL#
ENGINEERING REVIEWED BY DATE
IX ADD ESS.
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FIRE REVIEWED BY DATE
CITY ZI TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
� REO'D COMPLETED EXE I
CSC i3 YES NO m
CA# ZONE SIGN AREA. HEIGHT
-r PROPERTY TAX ACCOUNT PARCEL NO.
ALLOWED PROPOSED ALLQWCO PROPOSED- _
WAIVER i7
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wi v'J / �J � t i T G/ / STUDY 13
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) N =
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR D IT!
COMMERCIAL COMPLIANCE OR i m 0
❑ ADDITION MIXED USE ❑ CHANGE OF USE z O
REMODEL ❑ PARKING LOT AREA PLANNING.REVIEWED BY Di7zla
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MULTIFAMILY ❑ SIGN REQ'D PROVIDED / o OC�.�
❑ REPAIR ❑ GRADING ❑ FENCE _
CYDS
( X FT.) REMARKS m Z Z
❑ DEMOLISH. ❑ TANK ❑ OTHER - I C
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z ❑ CARPORT GE ❑ FIRE LER
ROCKERY RETAINING WALL ❑ FIREALARM r
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TYPE OFCON69TRLICTION C((ODE�� OCCUPANT O -�
NUMBER TNUMBER OF
GROUP Tsj
OF D� DWELLING Q SPECIAL INSPECTION CONSULTANT OCCUPANT T�
STORIES !r- UNITS' 171IT1
r . REQUIRED YES
DESCFFIBE WO TO Be DON (n
yc%Wu,qzkd2drids e,REMARKS O O
GEOTECH REPORT 1:/1
BY: I M n
L- STRUf,TURAL SIG I Z
BY: r I
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3 L VALUATION
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-yam L $�
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Description FEE Description FEE ►
Plan Check ,Stale Surcharge r� N
HEAT SOURCE LOT SLOPE% VESTED DATE 1 Z
Building Permit ; City Surcharge O
PLAN CHECK NO: J Plumbing Base Fee m
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
I DONMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading t
SEPARATE PERMISSION,
E Engr. Review
r PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) j
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. DepositMc;
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
LNORMLIMIT
LAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
ED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # r�
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALLBuilding Official or his/her Deputy: and Fabs die paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided
IN VIOLATION OF THE L CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS YION 1 SURANCE AND RCW 15:27, SIPITURE D TE
SIGN 0 ER AG TE SIG D (425y)
P40 W
i
771 �0220 RELEASED B ' DATE J
ATTENTION EXT. 133301 G) �-
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI _ INAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK • OWNER GOLD - ASSESSOR
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