The URL can be used to link to this page

20050777.pdfDATE RECEIVED , � J � ,.� [PERMIT EXPIRES �t&ml% PERMIT �) CITY OF EDMONDS NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT# ADDRESS tT.N OWNERNA1t,��[[MAME OF BUSINESS � 11�/ ] f0, SAIC,PLAT NAMEISUBDIVISION NO.O LID NO W MAILING ADDRESS C LID FEE S �� y ,Qs�p/ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApINovm ❑ 0 /� (/ - RW Pamid Ragmrad ❑ - Stleai Use Pamul P.equaed ❑ CITY ZIP TELEPHONE EXISTING-_, PROPOSED _ nspc�tionRequited ❑ Sidenalk Requund E3REQUIRED DEDICATION FT woring required ❑ NAME METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED YES O NOD Lu Lu W W I_ ADDRESS REMARKS W UOWNERICONTRAC'TOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE Q W CITY ZIP TELEPHONE CBI.# ENGINEERING REVIEWED BY DATE C ADDRESS v 3 lvJ FIRE REVIEWED BY DATE W = CITY ZIP TELEPHONE 5 l%oa/� ��010 zoo • 7y� LL LICENSE NUMBER EXPIRATION DATE By VARIANCE OR CU SHORELINE OR ADB# INSPECTION PA STAT I �j�� REV'D COMPLETED EO EXEMPTfxjrl ©YES ONO miff -i PROPERTY TAX ACCOUNT PARC LNO. CA# ZONE SIGN AREA HEIGHT Q WAIVER D ALLOWED PROPOSED ALLOWED PROPOSED C STUDY D ❑ NEW ❑ RESIDENTIAL PLUMBINb / ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT. SIDE REAR FRONT UR SIDE REAR L7 COMMERCIAL CE OR _ ❑ ADDITION ❑ CHANGE OF USE i MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE g REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED El❑ GRADING © FENCE REPAIR CYDS X FT.) REMARKS OTHER ❑ DEMOLISH ❑ TANK N iti� A� �� GARAGE RETAINING WALL FIRE S _ ❑ CARPORT ❑ ROCKERY ❑ FIREALLER ARM ,/,r_// CL IV (TYP USE, BUSINESS OR ACT I Y) EXPLAIN: re TYP C N TF TI GROUP ANT w NUMBER NUMBER OF M OF DWELLING SPECIAL IN ECTION CONSULTANT OCCUPANT i 0 STORIES UNITS LOAD -i REQUIRED YES .. SCRI4F WORK T(1 RF nf�l� L �/f�� . /rtr� /zip�;s-/�u��TGw o ��a� o p /{� /�% O GEOTECH REPORT m BY: STRUCTURAL DESIGN _ BY: t,JO 2 VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE _ Building Permit City Surcharge k PLAN CHECK NO: Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading J SEPARATE PERMISSION. I= Engr. Review W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) 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 i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection 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 1 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due Z NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.• Recording Fee Receipt # 7 I HEREBY ACKNOWLEDGE THAT 1 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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hlslher Deputy: and Fees are paid, and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged n space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 16:27, OFFI IALS SIGNATURE DATE SIGNATURE (OWNER AG NT ' DATE SIGNED Ste, (425) af ft �p•o3 771-0220 RELE /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- ORIG L -FILE YELLOW -INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 I IRC110, PINK -OWNER • GOLD ASSESSOR 1010+ PRESS HARD - YOU ARE MAKING 4 COPIES 0 --I M CO vM C o OC MM z ! C) C Z I r = I N I j O " I mrn ii v N CNC i X I � l , 2 Z Z f O ' 0 j m i