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20050821.pdfDATE RECEIVED v CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OW R NAMEINAME OF BUSINESS MAILING ADDRESS CITY ZIP TEL HONE _ J PERMIT EXPIRES PERMIT NUMBERJOB i�--�✓ —V ADDRESS/27� l� iJ� SUITEIAPTp PLAT NAMEISUBDIVISION NO. / LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permd Required D Street Use Permit Requited 0 EXISTING y7^(R,�,+^-,'�-,",jPROPOBEO^"•-"}"�^�'� """"'�'�= nspecio, equ d O REQUIRED itl© tafr re��d Sidewalk Roque O Underground E3 Wein re uir d E3 METERS Pre sum re a '•! '�Faif>�dip r0V E UIRED fist de�r �:t se' S� 4-ank shall e(ES o NO o REMARKS W OWNER/CCI • fMvir LU SP�16TB �TOPI1?R®S IfS�OIPTRCtlITRi GE _ L7 ENGINEERIADDRESS � 1}E�(I W By DA ° 61• �' vefil Co:mentors required iorifuel�huLrnir: I1jji'61nrP:;P^ CC! 2* It ~ CITY P, TELEPHONE FIREREVI 1�6Uh Y1Y3st(::�i�'I 3pJ,tt(:CS. �JtICTSI0Z,2 z z�} STATE LICENSE NUMBER EXP OI�OATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBtI INSPECTION SE P\ <`/DAT REOTI COMPLETED EXEh1PT L j6; 0 YES ONO L� CJ CA# ZONE SIGN AREA HEIGHT -r PROPERTY TAX ACCOUNT PARCEL NO. WAIVER O - - ALLOWED PROPOSED ALLOWED PROPOSED Uj Z� 6606yr � C✓ V STUDY O ❑ NEW I](t RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) �"C A ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR COMMERCIAL COMPLIANCE OR z ❑ ADDITION 1:1 CHANGE OF USE z ❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE 5 ❑ REMODEL El MULTIFAMILY ❑ SIGN REO'D PROVIDED ❑ REPAIR ❑ GRADING CYOS ❑ 1 ENCE X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER GARAGE RETAINING _ ❑ CARPORT ❑ WALL LER ROCKERY ❑ FIREALARM a (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: S `v IT► l' NCM OCCUPGROUPANT U CNUMBER NUMBER OF OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT p STORIES - - UNITS - LOAD DESCRIBE WORK TO BE DONE REQUIRED YES REMARKS _ o L GEOTECH REPORT m G BY: STRUCTURAL DESIGN / BY: VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT R LOT SLOPE% VESTED DATE Building Permit City Surcharge PL CHECK NO: Plumbing, Base Fee11111111 Oi O THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical tBE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin J DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g 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 U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fife Review Plan Chk. Deposit UJI IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF z 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 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 his/her Deputy: and Fees aro 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 acknowled ea in space provided. WORKMEN'S COMPENSAT SURANCE AND RCW 18:27. F CIAL S NAILIR _ DTE ke 4GNEIRE (O/WN 0 ACiE : / DAT NEO (425) �� G��C`/���—r'7 �1 X0220 RELE ED Y ATE TION 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- ORIGIN\ . FILE YELLOW -INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC1101 IRC110. PINK -OWNER • GOLD - ASSESSOR 10104 PRESS HARD m YOU ARE MAKING 4 COPIES Z 0 m C m� 0 O0 (= 2 m M Z Ate_ az CA wn MMI I I. mm 0 N r tK0) Zr i 0 X 2 a r � 2 Z 0 ! Mai m 'i i i, I `I