20050851.pdfDATE RECEIVED t� I
CITY OF EDMONDS
I PERMIT EXPIRES
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NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ���1. S�UIITTE//APT#) /�
ADDRESS I I L)Cj /` C^-1 "L e C� !\ L—�/oo/V
OWNER NAME/NAME OF B�ISINESS 1 I C�-
1�3 1 t' �— �i PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
l ` t,• t LID FEE $
MAILING ADDRESS l
p — ..—. J TESCP Approved o�
e L � a_ 0 K ) � �� ( C7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP SAW treet eUse Permit Roq'd Q
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required 0
Sidewalk Required
r � m 0/\ . `����. REQUIRED DEDIcA"TION �, t Underground
11 V LJ ` l (( T� [try ing required E3
NAME METER SIZE 10
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CITY ZIP ITELEPHONE
NAMEI '/CBL•#
SLC / i 2 Ory( G-• (� a� f \�, �{ T� — ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE REVIEWED BY DATE Q
CITY ZIP TETONF„M
TATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE
CE REO'D POSTED'
✓(t ( i C GI 1't { L.il' ot)I I R OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
PROP/l
PROPERTY TAX j'l
ACCOUNT PA,RrCEEL� NO.. NIIJI C� /� COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
0 O :3 (4.t1.•' C� G V O l EXP
/ MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ NEW RESIDENTIAL PLUMBING
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR c7
COMPLIANCE OR Z
❑ ADDITION ❑ COMMERCIAL ❑ GRANGE OF USE _
PARKING LOT AREA PLANNING REVIEWED BY DATE a
1:1 REMODEL 1:1 MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑ REPAIR 1:1CYDS
GRADING ❑ FENCE X Fr) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
❑ GARAGE CARPORT 1:1ROCKERY NING WALL ❑ FIRE ALARM FIRE LER
(TYPE OF USE, BUSINESS OR ACTH EXPLAIN:
11 CHECKED BY. CON RU O CODE OCCUPANT
ta i ."� GROUP
4(14
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTIOR AREA OCCUPANT
STORIES UNITS NUMBER REQUIRED ❑YES LOAD
DESCRIBE WORK TO BE DONE �1
1 TRE ARK01REMARKS
+ PROGRESS INSPECTIONS PER UBC 108/ IBC1091IRC109 FINAL INSPECTION REO'D 9
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�G' Com. Y� j Description FEE Description FEE
40 Plan Check State Surcharge
HEA SOU CE GLAZING % LOT SLOPE %
Building Permit City Surcharge ti C.
PLAN CICK NO: VESTED DATE Plumbing ' Base Fee
Mechanical r /U
THIS PERMITAUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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
°' PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 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
M 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
9 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
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 Foos are paid, and .
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATIRANCE AND RCW 18.27.
����� Oki IGN T RE /'lilcs
SIGNA URE (OWNER OR EN DASIGNED `'��-
"� 7 . 1 m0220 RELEASE BY DATE
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL 0R A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW I INSPECTOR
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK . OWNER GOLD -ASSESSOR
os/os PRESS HARD =YOU ARE MAKING 4 COPIES