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20050782.pdfDATE RECEIVED Le CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION ER NAMEINAME OF BUSINE .S 1 NG ADDRESS CITY NAME ADDRESS ZIP I TELEPHONE ZIP PERMIT EXPIRES t1UMBER ERMIT CJ "(.' U r� DRES SUITE/APTp 2A 83 b W01 99 &j m6 tit PLAT NAMElSUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved d RW Permit Required E3 Street use Permit Required O EXISTING _ PROPOSED Inspncucn Required O Sidewalk Required a REQUIRED DEDICATION _ FT Underground I7 Wien re ueed O METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES O NOD z W REMARKS w OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE z 3 z w NAME CBL# �CT 1rV I (_ �a WA J n c 1 ENGINEERING REVIEWED BY DATE Iz ADDRESSOR I S2 lU TELEP`HONE A FIRE REVIEWED BY DATE w CI I m STATE LICENSE NUMBER EXPIRATION DATE IEC BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA StPOITLQ-3 �� REO'O COMPLETED EXEMPT �—� j ~I� � YES VUQ '—.. CA# ZONE SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PAR( ELJ�OI. v!) �j'(�'/f WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED a /9L7 STUDY O ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR COMMERCIALCOMPLIANCE OR z ❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE z REMODEL ❑ PARKING MULTIFAMILY SIGN REO'D PROVIDEDLOT AREA P NN REVIEWED BY D9T g ❑ ❑ �JJ ❑ REPAIR ❑ GRADING CYDS ❑ FENCE. ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK GARAGE O z 13 CARPORT RO KIERY WALL ❑ FIREALIRE ARMKLER (TYPE OF USE, BUSINESI Q CTIV TY EXPLAI CO C GROUPANT GNUMBER NUMBER OF r OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT O STORIES UNITS REQUIRED D YES LOAD DESCRIBE WORK TO BE DONE REMARKS z GEOTECH REPORT BY: m VFb STRUCTURAL DESIGN BY: VALUA?TION` a CN'tn 11�ei $ Description FEE Description FEE �.� Plan Check State Surcharge HEAT SOURCE 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 Gradin J DONMAIN'(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g t SEPARATE PERMISSION. � 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 Engf. Inspection *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit to 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 # sALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due r = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.• Recording Fee Receipt # I, 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 Foes are paid, and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided. IN VIOLATION OF JHE LA119B.ZODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION WORKMEN'S CO NSAT SSNCE AND RCW 18:27, C OFFICI S SIGNATURE SIGNAT (OW O ENT). DATE SIGN (425) //6ATE Aj 6- le9 , .771-0220 RELEASED BY / DATE A N N EXT. 1333 IT IS U WFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FIN L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE • YELLOW • INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC110. PINK -OWNER GOLD - ASSESSOR 10104 PRESS HARD - 'YOU ARE. MAKING 4 COPIES z 0 m N C My O awl OC. m x M Z, ..I jo Dz r= CnI l 0T Mm 1. oN nm 9 Cl) t Zn �. r awl I 0 ;I D �. z z 0 n M