20050829.pdfDATE RECEIVED ✓
PERMIT EXPIRES
CITY OF EDMONDS Nu BIER
CONSTRUCTION PERMIT APPLICATION If ODREss m
OWNER AMEINAME 7 BUSK SS �
Lv1_1 %Z �y U �� / PLAT NAMEISUBDIVISION NO. LOT NO.
1 W MAILING ADDRESS
G 4 �� II , I � PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY /t ZIP TELEPHONE EXISTINGPROPOSED
ti\(U �V ' `� 1✓ / J' REQUIRED DED
NAME METER SIZE Walla •;�, t'C�P QF
Lu 0115
t ADDRESS REMARKS
TELEPHONE
SUITEIAPTn
LID NO.
LID FEE 5
TESCP Approved
RW Permit Required
Street Use Permit Requited
Inspection Requited
Siduwalk Requited
.YES
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rt ADDRESS ER'6Y bY (; Y S J
.FIRE REVIEWED BY � -r qg�"pp �p DATE
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SNUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBft INSPECTION SEPA
TATE LICEN
/y A� r,�1 / /, 1 J j r REO'D COMPLETED EXEMPT
J 1 I" D 0(e. !1 f� .L �^ 1 JL.� 11 0 YES O NO
a PROPERTY TAX ACCOU PARC L NO. CAN
ZONE " WSIGN AREA HEIGHT
WAIVER y - (ILLOWED PR$Pa�SED'" "7{CL'O4SC[T'" POSED
a7�l UV ��lJ STUDY or If vel >l C11nI (".Q'CfiiS degItiiN•L
❑ NEWRESIDENTIAL PLUMBING / MECH LO CQQVERAGE R p �s�(r`r�d ,!� SED SETBAC S (FT.)
ALLOW 4IIRDii iliFTIC� l�i(�R'`%ti u 3 RIDE REAR z
❑ COMMERCIAL COMPLIANCE OR � Jt .7 i
❑ ADDITION ❑ CHANGE OF USE -"'"`^ �^ " z
❑ MIXED USE
PARKING LOT AREA PLANNING REVIEWED BY DATE S
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑ REPAIR ❑ GRADING CYDS ❑ FENCE
( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ Ol'HER
GARAGE Z El ❑ ROCKERY RETAINING WALL ❑ ,FIREALARM SRINKLER
1_ 1. � I,., ...� , .-...,, Aoki. r,
k I I ITYP CTION OCCUPANT
tr GROUP
Lu NUMBER NUMBER OF
OF DWELLING I SPECIAL INSPE TION CONSULTA OCCUPANT
OSTORIES UNITS LOAD
DSPRIBE WORK TO BE DONE REQUIRED D YES
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REMARKS r,
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GEOTECH REPORT m
BY:
STRUCTURAL DESIGN
" � BY:
VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing , U Base Fee ciU
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical /)''� 0 1(J �/
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Gradlfl
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 Engr• Inspection
y"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
U11 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 #
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
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. DueML
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt # QUA
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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Oficial or his/her Deputy: and Fees are paid, and
IN VIOLATIO E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKME ATION INSURANCE AND RC .18:27. OFF A SI NA E
ATE
(OWNER 0 N ): DATES ;:E/D (425) /Of or % ��� 771.-0220 BELE D E
ATTENTIO11III EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERI'1- ORIGINAL -FILE YELLOW • INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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