20050854.pdfr7TE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
'0131 1, 1 y ti",
z D' -7
CITY ZIP
�J MOVI
NAME
ci� 1/1
Axe.
01 TELEPHONE
ADDRESS
/ bii-ltiG
CITY ZIP TELEPHONE
,e,f:k Glj
STATE LICENSE NUMBER E. ATIT DATE
I I
�OX T-(.f 15q cam 11i I (A 0
PROPERTY TAX ACCOUNT PARCEL NO
t
0 -7 0 0
NEW
RESIDENTIAL
PLUMBING / MECH
r—j,<DDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
MIXED USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
El
FENCE
I . x—
DEMOLISH
TANK
OTHER
DGARAGE
El
RETAINING WALL
El
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
I.TYPE OF USE, BUSINESS OR ACTIV21 Y) EXPLIAPI
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIRF WORK TO BE DONP
PUA
)�: ? I I PERMIT EXPIRES_
PERMIT
NUMBER
JOB SUITEIAPT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO LID NO
I LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approven
RW Permit Requitwi
EXISTING PROPOSED
Street Use Permit Requitucl
inspection Required
REQUIRED DEDICATION FT
Smawalk Requirw
und(frg,ouna
Waino remered
METER SIZE
LIIN7
I
NO. OF FIXTURES
PRV REQUIRED
_e�
YES13 NO13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
-;-?A /P / /U V1 OU y
(4-71-) F�hJA-L,
ENGINEERING REVIEWED By,
TM t
FIRE REVIEWED BY
Ll
DATE
0
z
E
Uj
W
z
35
z
UJ
Lu
BY
VARIANCE OR CU
SHORELINE RADBII
INSPECTION
SEPA
REO'D
I 13YES )(N
COMPL 'ED EXEMPT
I X
01
CA# 0_G—
ZONE
SIGN AREA
H IGHT
WAIVER�
ALLOWED PROPOSED
I
ALLOWED PROPOSED
STUDY
, 9f
-2—e5 , I 1 3 1
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FREINT 6413E REAR
I
IW15
F=klm- 44R-8fDE 'V'
47�5 N
NIC',
35, (9 1 -Z.2� I ID
PARKING
REO'D PROVIDED
LOT AREA
I
&I
PLANNING REVIEWED 13Y DATE
tA 0 at/ I C1 /0G-
I N/C
FT.)
REMARKS
_r_jN
., DUMS I WOO&W
HEAT SOURCE LOTSLOPE% VESTED DATE
PLAN CHECK NO- o- (5
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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
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
IN VIOLATION OF THE LAVO&&ODE OF THE STATE OF WASHINGTON RELATING TO
WnRKMFw&COMPENSAT9W_1NS2"hANCE AND RCW 18:27.
DATE SIGNED
TYPE OF
OCCUPANT
GROUP
]lifli/ I I %_-z _-.1 I . It N..01 I
SPECIAL IN9PE6TION CONSULTANT, OCCUPANT
REQUIRED- 'YES I I LOAD , I
REMARK�
GEOTECH REPORT
BY:
STRUCTIJf�PgSIGN
BY A V)
VALUATION
$ WI-5
& scription
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
4
FEE Description FEE
f - // ��C)
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit /:I,�
Receipt #
Total Amt. Due 'wea
''n f,
Roceipt # ��z —_ -
APPLICATION APPROVAC
This application is not a permit until signed by the
Building official or his/her Deputy: and Foes are paid, and
receipt is acknowledged in space provided
ATTENTIOV EXT. 1. 333 1 vtl j/
IT IS UNLAWFUL" 0 US OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL lNSPEC%0jHAAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110-
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
DAT E
ORIGINAL -FILE YELLOW -INSPlfCTC
PINK. -OWNER GOLD - ASSESSOR
&.4
0
z
(a
z
0
11
0
M
-n
M,
C
IT!
0
10
0 C
M
M Z
IC) -q
C _z
0 _n
M M
0
0
0 M
C cl)
9 CO)
M 0
Z
z
W
z
0
i
0
M
I
'13 NOTED
E -R
RING
14
Wk
FINALPROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT-cboRDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
I THAS13 SIGN
E NGINEERING DIVISION DATE
0
PLANNING DIVISION DATE
M
I 'LEASH SIGN
PROJECT AnVq
-n
SITE ADDRESS -1 VJ
M
M
0
PERMIT # --aE5V ADB# bATEINSPECTED
0 C
M Z,
DESCRIPTION OF WORK TO BE I,NSPECTED
C
A field inspection was conducted to determine compliance with -approved. plans. �inal'approval-
denotes that there are, no objections from tile above signed Department to the release of.
0 -n
PERFORMANCE BONDS and the granting of:
_n
MM
0 V5
0
'M
GR. ANT FINAL PROJECT APPROVAL.
0
C Cn
9 Zn
M C)
Z
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
z
0 Copy, of CONDITIONS given to owner/contractor. by inspector
CD
z
0
FAILED FINAL INSPECTION.- OUTSTANDING ISSUES'
0
M
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
p
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:oCaprv1 3/25/04