20050814.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
x MAILING ADDRESS
0 410 0/n� /air .v
CITY ZIP TELEPHONE
154040N0 5 0/4
NAME
C ADDRESS
x a/
1 JCP
j FPERMIT EXPIRES L141
PERMIT
NUMBER
JOB SUI /A a
ADDRESS
f •
i PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved ❑
RW Permit Required ❑
Street Use PmmdRequired 13EXISTING PROPOSED
_ _ Inspection Required ❑
Sidewalk Required ❑
REQUIRED DEDICATION FT Underground E3Wirino ro uudd ❑
-METER 512E LINE SIZE J.NO. OF FIXTURES PRV REQUIRED
YES 13 NO O
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REMARKS m
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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NAME A '. CBL#
ENGINEERING REVIEWED BY DATE
x ADDRESS
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FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE w
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
QQ C.�E ^ �� ]] q �r /� REO'D COIAPLETEO EXEh1PT
/T�J4/�4�"$/Jf / 1V ' -C � /)' OYES ONO
(,I CA# ZONE SIGN AREA hiEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. �/ WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
L A 7O3a. elo 6 2;t / b STUDY O
❑ NEW ❑ RESIDENTIAL � PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
/ ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
f�X COMMERCIAL COMPLIANCE OR
❑ ADDITION !!!KKK❑K il� MIXED USE ❑ CHANGE OF USEi
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADING FENCE
El REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH 1:1TANK E]OTHER
_ ❑GARAGE RETAINING WALLr0FIRE SPRINKLER
CARPORT ❑ ROCKERY �1 •ii 0
d(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
C C !�G1� M / TYPE OF CONSTRUCTION CODE OCCUPANT
U li 7►j-1 • l fV GROUP
GNUMBER NUMBER OF
OF DWELLING SPECIAL. INSPECTION CONSULTANT OCCUPANT
p STORIES UNITSLOAD
DESCRIBE WORK TO BE DON REQUIRED YES
F 'it9M f G //IC hp/it/ MARKS i
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terga "C444 0""r 1344,100) f N GEOTECH REPORT
BY: m
STRUCTURAL DESIGN
BY:
—IG �liL/ VALUATION
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Description FEE Description FEE
Plan Check State Surcharge !260
HEAT SOURCE LOT SLOPE% VESTED DATE —�
Building Permit City Surcharge
PLAN CHECK N 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 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.). WILL REQUIRE 9
t SEPARATE PERMISSION.
v 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
2 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.*
Recording Fee Receipt # f
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 ponnit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC•
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or Deputy: and Foes are paid, and
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 18:27.
SROR +^ DATESIGNED(425) °F I NATO DATE
7710220 E DBY q ATE
ATTtNTION 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 •INSPE TOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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