20050832.pdfRECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF 13USINESS
MAkX �Tc)hms.oAj
MAILING ADDRESS
S
I TELEPHONE
CITY ZIP
1j�FT)yrDtq6 qoorl
NAME
ELEPHONE
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
1'�� 57
SUITE/APTO
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO,
&,ST,6Te51
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
[3
E3
EXISTING PROPOSED
Street Use Permit Required
Inspection Requited
13
13
Sidewalk Required
13
13
REQUIRED DEDICATION FT
Undrittirmund
Winne required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NOO
z
REMARKS
Lu
111
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
CBLN
&A _TA1 L ENGINEERING REVIEWED BY DATE
q: 3
W AD
L)
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
LL
STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINEORADBO INSPECT19W SEPA
COMPLETED I EXEMPT
;PfE'S 13NO
TAX ACCOUNT PARCEL NO. CM CA# NE N AREA HEIGHT
I I
WAIVER [3 rALLOWED I PROPOSED I ALLOWED I PROPOSED
W
616/.- OIL -0e) STUDY [3
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) I PRO POSED SETBACKS (FT.)
COMMERCIAL ALLOWED P E: FRONT SIDE . REAR FRONT UR SID I E REAR
ADDITION COMPLIANCE OR z
171 z
MIXED USE CHANGE OF USE z
r2" REMODEL �ING LOT AREA PP)_7� EVIEWED BY DATE
MULTIFAMILY SIGN RE ' P' PROVIDED ZG
L-2 60
GRADING FENCE r 1 1 q /
REPAIR CYDS X FT.) REMARKS
DEMOLISH E] TANK OTHER Mh K
A14-
GARAGE RETAINING WALL FIRE SPRINKLER L AXAA WA I
z CARPORT ROCKERY FIRE ALARM
(TYP BUSINES 3 OR ACTIVITY) EXPLAIN:
rx 0 TYri OF COb*TRUCPON OCCUPAN
GROUP
uj NUMBER NUMBER OF
C' OF DWELLING
In STORIES 2, SPECIAL INSPECTIONU CONSULTANT OCCUPANT
0 UNITS LOAD
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
t_l�n � L .
4sT 'N a Lo
Ig -L GEOTECH REPORT M
Pvc- 0 L) BY:
1,S Ti N. STRUCTURAL DESIGN
BY:
/Z H R) VALUATION
$)
Description FEE
MCI C4Vdr_r0 �W6. >Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% - — - F__7ESTE? DATE City Surcharge
Building Permit
PLAN CHECK NO: Plumbing Base Fee <z' gs
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUI31C
9 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
lz PERMIT APPLICATION., SEE ECDC 19.00.005(A)(5)
W
PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*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
a: 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 Or ANY CITY ORDINANCE LandscapeInsp. TotalAmt.Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt # 01M I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hisJher Deputy: and Foes are paid, and
IN VIOLATION OF THE L OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORK A S1
,�51iir3-G,0MPENS,' SURANCE AND RCW 181:27.
FF�Cf '_�GNAT OAT
sl NATURE NEq AGEN DATE SIGNED C11
(425)
-2�9 OJ 1 771-0220 LEA BY A
I N 17
ATTENTION 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- 0 IGINAL - FI E - ELLOW - INSPEC611
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. 'i\JF INK - OWN(R)GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
1
0
M
-A -n
3:
M
C
M
0
-40
0 C
-4 K
X M
M Z
10
C
0
o -n
n
.Mm
0 _0)
0 r-
0 M
C/)
M 0
Z
71
X
--I
x
>
z
z
0.
0
M