20050788.pdfDATE RECEIVED r
`t wo 7 [PERMITEXPIRESPIENm.
Z�S
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION DBDRESSSUITEIAPT#
OWNER NAME/NAME/OF VUSINESS
n
�CC LJ h I f
NO. LID NO.
PLAT NAMGSUBDIVISION NO.
W LOT
IY MAILING ADDRESS LID FEE $
0 (J�����d o / !^ ��RWPee . PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP PApproved ❑
l.Li 1 RW rmit Required ❑
Street Use Permit Required ❑
CITY FW -4) 21P TELEPHONE ^ - EXISTING PROPOSED _ Inspection Required ❑
( / v Sidewalk Required E3
REQUIRED DEDICATION FT Underground ❑
Wiring required ❑
NAME METER SIZE LINE SIZE mTO. OF FIXTURES I PRV REQUIRED
14 - YES O NO O z
U I I K
W W
=ADDRESS REMARKS W
U OWNER/CONTRACTOR RESPONSIBLE FOR ERQtaRQUDRALLNAC6�w Z
L7
tY
CITY ZIP TELEPHONE irl/P, B or L Vellt coulllector5 requires w
oil fuel -burning 2PP l:dll >v.
NAME CBL# I illughJ
setENGINEERING REVIEWED BY DATE
CK ADDRESS - \
FIRE REVIEWED BY DATE
zCIT ZIP TELEPHONE
U
IDTTV
STATE LICENSE NUMB EXPIRATI DATE By AA! z/2 I 24�96 r7*?W� VARIANCE OR CU ra fjT (p��EPA
� t ?lv9 q, O_ E�� HA � IN �l aMPLET D EXEMPT
$IIALLBE ��
a PROPERTY TAX ACCOUNT PARCEL NO. /�' CA# ZON jji' A� r HEIGHT
J W �� L./O ��/ v STUDY Q ALLOWED PROPOSED ALLOWED PROPOSED
U
❑ NEWIYRESIDENTIAL PLUMBING 1 MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR r,
❑ ADDITION 1:1 13
13COMPLIANCE OR 1 1 2 z
1:1 PARKING USE CHANGE OF USE z
❑ REMODEL ❑ PARKING A PMW(ME8jFjW + DATE a
❑ MULTIFAMILY SIGN REQ'D PROVIDED HI t 8 INSTALLED ON THE
GRADING FENCE [irce
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS MID A03 IT MOMS TIM DbItiDWO
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑ CARPORT GE RETAINING❑ ROCKERY WALL ❑ FIREALARM FIRE LER
a (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
`J�• TYPE OrgON D OCCUPANT.
v / GROUP
U) NUMBER NUMBER OF
OF DWELLING SPECIAL INSPE TION CONSULTANT OCCUPANT
p STORIES UNITS LOAD
REQUIRED 13 YES
DESCRIBE WORK TO BE IYONE
REMARKS z
O
74V j
GEOTECH REPORT
BY: m
STRUCTURAL DESIGN
" BY:
VALUATION
llr Description FEE Description FEE
Plan Check' State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE r
Building Permit City Surcharge
PLAN CHECK NO: Plumbing r 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, MAROUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION, Engf. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
4 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
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 #
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.' 7l
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 his/her Deputy: and Foes are paid, and
TION; AND IN DOING THE WO UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPEN ON I SU NCE AND RCW 18:27. O(Cp NATURE DYE
4AENTION
(OWWnN`ER GE t DATE IGN D S (L�25n)n
L J 771 -0220 RELEAS BY DIANE
EXT. 1333
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW-INSPECTOI
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110, PINK • OWNER GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES