20050766.pdfr�lc�tit>, Attic, )0Mi6wo
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
Q NER NAME/NAME OF BUSINESS
MAILING ADDRE
CITY ZIP TELEPHONE
rab&4-s A✓& / % LU
ADDRESS
j PERMIT EXPIRES'- f ,
PERMIT _ f
NUMBER ,
ADDREV7
Jola SS n SUITE/APT #
C
rREOUIRED
UBDIVISION NO. L NO. LID NO,
LID FEE 5
T OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Requited ❑
Street use Permit Required ❑
PROPOSED inspection Required O
Sidewalk Required ❑
EDICATION FT Underground ❑Wirm re ueed ❑E LINE SIZE NO.OF FIXTURES PRV REQUIREDYES Di NO13 z
w wNTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE _
u
z
W
d�sG77t� ��/�7��� y`n ENGINEERING REVIEWED BY DATE
Y ADDRESS r
o� � QLLJr�
&/ �
U
FIRE REVIEWED BY DATE uj
CITYl ZIP TELEPHONE
STATELICENSE N /M�BER EXPIRATION DATE D BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
RE � G�G�/
4740
7 (1� q-lop►nf4� �q��' -�'�1 O YES D NO COMPLETED EXEMPT
"v (�(� CAN ZONE SIGN AREA HEIGHT X
Q
PROPERTY TAX ACCO T%P�R/C�E/L N�O.� WAIVER O ALLOWED PROPO ED ALLOWED PROPOSED
X TI �✓W OO STUDY 0 � r, ' • r '�jl L I
NEW ❑ RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT ! SIDE REAR FRONT LIR SIDE REAR O
❑ COMMERCIAL COMPLIANCE OR NO (� � N `AW Z
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE I i
PARKING LOTAREA PLANNING REVIEWED BY DATE g
REMODEL MULTIFAMILY ❑ SIGN REQ'D PROVIDED
r FENCE No ►-takN b --
pU REPAIR ❑ GRADING CYDS ❑ ( X FT.) REMARKS
//❑_" DEMOLISH ❑ TANK ❑ OTHER
z '❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIRE ALARM
a (TYPE OF USE, BUSINESS OR ACTIVITY) XPLAIN:
- TYPE OF CQNST UCTION CODE OCCUPANT
uGROUP r7
oNUMBER NUMBER OF !�
OF 7 — DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES /� UNITS LOAD
-i REQUIRED Q YES
DESCRIBE WORK TO BE DONE
REMARKS z
// / o
�/ G� Cyr �� DGEOTECH REPORT �
�� BY: m
STR CT RA DESIGN _
�1 BY:
i/ 00( VALUATION
$ I Iloolo
Description FEE Description FEE
Plan Check Slate Surcharge �7v
HEAT SOURCE LOT SLOPE% VESTED DATE�-
Building Permit S City Surcharge
PLAN CHECK NO: - Plumbing Base Fee
k,2 Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
iSEPARATE PERMISSION, Engr. RBVIBW
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
4 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
r 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 At -'
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 At
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROV L
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, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or acknowledged
edgediDeputy: and Foes are paid, and
IN VIOLATION OF THE LABO CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged to space provided.
WORKMEN'S COMPENSATI RANCE AND RCW 13:27,
OFF SI TURE 9&/05
SIG RE (O N ORA T): DATE SIGNED %(425)
~� l `'VVV� 771 0220 BELE B DATE
A ENTI N EXT. 1333Cj
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 / IBC110 / IRC110. PINK -OWNER • GOLD - ASSESSOR
,D,o4 PRESS HARD an YOU ARE MAKING 4 COPIES
0
n
M
tool
cM
m�
-1 O
Oc
= K
mZ
O -oll
ammil
DZ-
mmw
T
M
m
ON
nm
C CO)
r zr
X
Z
t NMI!
CD_
O
m