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20050803.pdf' DATE RECEIVED r ( PERMIT EXPIRES USE PERMIT CITY OF EDMONDS ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JO8SS mmlmct<�,Ow, T# ADDRESS OWNER NAME/NAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. � Vie,-✓r.nl� - G �,r-,�,� I� Nis• FEE S W MAILING ADDRE 6 I D p Approved I� p J S w4 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required u Street Use Permit Rq'd CITY ZIP TELEPHONE EXISTING —,•PROPOSED Inspection Roquired Sidewalk Required ��tJV�a as �xozv ZS �� 13 / REQUIRED DEDICATION FT underground ine pr required 13 NAME 0 6 METER SIZE LINE S/IZE NO. OF FIXTURES PRV REQUIRED J O YES ❑ NO ❑ z {Wu W G ADDRESS REMARKS = V OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE M W (� CITY ZIP TELEPHONE O&f= NAME I CBL# ENGINEERING REVIEW D BY DATE ADDRESS b FIRE REVIEWED BY DATE Q 'CITY�r ZI TELEPHONE VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND STATIf LICENSE NUMBER EXPIRATION DATE CHEC / REO'D POSTED 'J YES NO S cZ�ssesG Pf Qs Pi D� 4 /ice /b SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCELLED. �� `` COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED t7 � (, TT 7T' 'rlA' 1 1 EXP © NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR COMPLIANCE ORt V N DC1P- �I SO Z _ ❑ COMMERCIAL ❑ NO LN�N ADDITION ( 5 M S S6T�AC�- _ RANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE og ❑ REMODEL ❑ MULTIFAMILY SIGN REQ'D PROVIDED ❑ REPAIR ❑ GRADING FENCECYDS ❑ ( X FT) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER GARAGE _ ❑ CARPORT ❑ RETAINING FIRE LER R CKERY WALL ❑ FIRE ALARM (TYPE OF USE, BUSINES OR ACTIVITY) EXPLAIN: CHECKED BY TYPE OFC STRUCTI CODE OCCUPANT GROUP NUMBER NUMBER OF CRITICAL OF DWELLING AREAS %1 ��bj O SPECIAL INSPECTION AREA OCCUPANT OSTORIES UNITS NUMBER V1 ww REQUIRED 11 YES LOAD DESCRIBE WORK TO BE DONE -A4.1L1M,0.A1T 31100 REMARKS PROGRESS INSPECTIONS PER UBC 106/IBC10911RC109 FINAL INSPECTION RE01D 9 m VALUATION $ Description FEEDescription FEE Plan Check t j/ 0 State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit 0 City Surcharge PIAN CHECK NO: /� VESTED DATE Plumbing Base Fee Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO i BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION, Engr. Review W PERMIT APPLICATION: 180 DAYS CL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 It ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE =NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION' Recording Fee Receipt rE 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 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALLThis application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF RiE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided. WORKMEN'S NSATION INSURANCE AND RCW 18.27. NEWO FF[ALS SIGNATURE DAJESIGNATURE N OR AGENT)J DATE SIGNED (425)� JD &ej� .� 771 0220 DTE ATTENT ON EXT 1333 C1 IT IS UNLAW ULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL INSPECTIO HAS BEEN MADEANDAPPROVALORACERTIFICATEOFOCCU oR INAL•FIL Y LLOW-INSPECTOR FANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. P K - owNE OLD -ASSESSOR Ds/oa PRESS HARD =YOU ARE MAKING 4 COPIES O m q co _. C M v 0 On M p � Z ca mm O5 n r C� K CA F � rm D D 1 Z 2 N Z 0 M