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20050781.pdf• DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BU S$L Cf� S w MAILINGADDRESS l/ CITY ZIP TELEP ONE NAME F- U W It ADDRESS PERMIT EXPIRES ZW& PERMIT NUMBER 577 2 JOB ADDRESS SUITE/APT# i PLAT NAME/SUBDIVISION NO. LOT NO. LID N L F $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESZP Approved O RW Permit Requited E3 Street Use Permit Required 13 ,EXISTING _ PROPOSED inspection Required O Sidewalk Required 13 REQUIRED DEDICATION FTUnderground O iWifirinfoQuired O METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0 YES O NO O Z W REMARKS W OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE L9 z w uT�k-4.3 ) I:S i. E F, a �aa+..� ••— NAME CBLg U"_, , il !NSPECHR Z ENGINEERING REVIEWIDAVITS s 41ALL NOT DATE VA a ADDRESS f q„ ACCEPTED�`' V S FIRE REVIEWED BY �}!• DATE W Z CITY ZIP TELEPHONE LL Se elf 14e in Z©co 7873 g2 STATE LICENSE NUMBER EXPIRATION AT VARIANCE OR CU SHORELINEORADB# INSPECTION SEPA REO'D COMPLETED EXEMPT �O YES ONO ICKED CA# ZONE SIGN AREA HEIGHT a PROPERTY TAX /ACCOUNT PARCEL NO. WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED W 45G� ! v coo omSTUDY O NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR ❑ COMMERCIAL COMPLIANCE OR z ❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE Z ❑ PARKING LOTAREA PLANNING REVIEWED BY DATE ElREMODEL SIGN REQ'D g MULTIFAMILY ❑ PROVIDED 1:1 REPAIR ❑ FENCE X FT.) REMARKS REPAIR CYDS ( ❑ DEMOLISH ❑ TANK L=1 OT FIRE GARAGE RETAINING _ 13CA PORT El ROCKERY WALL L❑�` FIRE ALARM SPRINKL R a(TYPE OF USE, BUSINES OR ACTIVITY) LAIN: TYPE OF CONSTRUCTIONCO GROUpANT w NUMBER I1 NUMBER OF o OF DWELLING / SPECIAL INSPECTION CONSULTANT OCCUPANT W STORI • UNITS - LOAD -� REQUIRED Q YES DESCRIBE WORK TO 8E ONEgas Iple%4. ' REMAR i % ) o GEOTECH REP9KT BY: to STRUCTURAL DESIGN BY: Ci ©©r_1A I'h CIL C %112� VALUATION Zao II t'(k $ ►� Description FEE Description FEE Plan Check State Surcharge HEAT SOU E LOT SLOPE% 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 BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC OONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading J SEPARATE PERMISSION. Engr. Review W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) n 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 W 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 # a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY = FROM. THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE e 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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hislhor 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 in space provided. WORKMEN'S COMPEN URANCE AND RCW 16:27. FFIA SIGN E DATE SIGNAT ): 0 T IGNED (425) . 9,16 \ 77144220 REL ASED B ATE ATTENTION if IF 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 -INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110. PINK • OWNER GOLD - ASSESSOR 10104 PRESS HARD YOU ARE MAKING 4 COPIES I �.. _ ,... ,...,_ .T... ...,. .. ..r .... .. „ ... ., r �,. � ._... , L.}, _ � _ _