20050866.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O NER NAMEINAMfi OF SI E S
u)1 1 /VTetv rri, 11
Cl MAILI G ADDRESS
I b D I cher tj S
CITYZIP TELEPHONE
>'i2a n s0Zu 112r 1/
NAME
[PERMIT EXPIRES
PERMIT
NUMBER
JOB - SUITE/APT#
ADDRES & I d ' ::A -
PLAT NAME/SUBDIVISION NO. LOT., LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 13
RW Permit Required 0
Street Use Permit Required E3
EXISTING PROPOSED- Inspection Required O
Sidewalk Required O
REQUIRED DEDICATION FT Underground O
Wainre cared O
METER SIZE LINE SIZE NO. OFfy(TURES PRV REQUIRED
�'�,� YES O NO O O
2
d
w
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
a
z
kiE nLa�iN,��n .% i/,ht'/InPDYln91 .� W
NAME CBL# 94 v
ENGINEERING REVIEWED BY ATE /
0
j�((J ADDRESS Ao
U
FIRE REVIEWED BY DATE
z CITY ZIP dIELEPHONE Ir
STATE LICENSE NUMB EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# .INSPECTION SEPA
A_ REQ'D COMPLETED EXE 1PT
ASD M I N A'P Is" O v e 10YES NO
CA# ZONE SIGN AREA HEIGHT
PROPER TAXACCOU TPARCEL 0.
a OWWAIVER O �\ p 5 • I ,y ALLOWED PROPOSED ALLOWED PROPOSED
STUDY O t^ Y' Pei W kw
❑ NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED. PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
ADDITION ❑ OMMERCIAL COMPLIANCE OR 3 5% ^j v5 1 Ib 1 Z 51 3q 23/ 25
❑ ❑ MIXED USE 1:1CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY. DATE g
*REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADING❑ FENCE REPAIR ❑ CYDS ❑ ( X FT.) REMARKS �0 Y a,� ra Lot) Y1 u 4vr ? I (m04 I y
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREALARM
ILd (TYPE OF USE, BUSINESS OR ACTIVI)-,)1 �✓:
( 1re 1�, TYPE O C N UCTION GROUP NT
GNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES UNITS LOAD
DESCRIBE WORK TO BE DONE j REQUIRED YES
1`;Cx��t1l U REMARKS z
0
GEOTECH REPORT
BY:
m
f,Ji
(, t Pcepl, kl rt"� STRUCTURAL DESIGN
�j BY:
VVA VALUATION
g $ 1ZI"
Description FEE Description FEE
Plan Check Slate Surcharge
OU E LOT SLOPE% VESTED DATE
Building Permit � City Surcharge
PLAN CHECK NO: 1 Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE N PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Gradin
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
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit�f r^
\ IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # -740 2
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 2 - q
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE r�
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 # ;2.7a6
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• CALLBuilding Official or his/her Deputy: and Fees are paid, and
TION; AND I DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLA OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
O
WORKME 'SWk
NSATION INSURANCE AND RCW 18:27, T
FFI IAS IGNATURE DAT
SI!:: T ( E RAGENT): DATESIGNED`,�Q aC�
I YV �J C I2&o a 771'0220 RELEA DBY DAT
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Wok
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW - INSPECT R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 1 IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
0
n
m
c
m
mo
-i O
OC
mz
10
DZ
r_=
all
mm
Or'
C
C Cn
r m0
•Z� r
X
I -•I
D
Z
2
W
Iz0
m
By order of the Building Official for the
City of Edmonds
All persons Are Ordered to
STOP WO
1
z
11
ONC
0
t
1
rn
_
�1 ,4
t
{ r r 3 ' d ••r�,,i ..,}yr Y '``..• t " Y c i as R r L 4!! ti I' 2 r.r F'f•;i ,^
Ici•y✓Z .:. 1 i v ,, 1 ...'
T gl uJ.,,-T' Yrfjy rR 1. 9;i ' /rf�`� •r ��c� `i` ii`i 42 C..F ,`a - l a tt' tJ/
/ r Address
�1ry.•i{..h 1, �,t'..� yt..11K: Ah :-'il.. Yl. Icy .t ..'.L. 't.. 4 �.� , j .,atit, t; Yt �4.iS�ir Y.�: f �r+' t '!' r{11 v
Y✓: 'A 5 a. r: r S . t, a r ( se.,•1 x t. [.,, t yG. t , r e eIF
S YS tl S d r a q) r m
r'+'}•invig' t =C. i' L �' •,! r_.. i:. "•?'x • t f
?; A r \tir r 1 1 r
'•�'aL JI!•„2r(.•il rrq '>]`l _ttxa tr •' .°�.:•x ° J .7. `,+: }Ra r 4 2 a b,r at r. �•,% m 0
'Property Owner;(if known). r�� �� �, tt <, p
i 1 ' -� n
'fix 1,, i ' rr , x' sv J" , r, �'. j1•; 'O C
1 f.' t. ..Y ,.r
lt
.,
` a Contractor:(if known) 0
rn
-fir r t:\.. !:' v;, t / �„ lir-rip. { /mom� z
n Q _ r v, r ") ''�r e t r F 1 } !+ (' ' i t 't RJ
r K , s e'at this address: A- :ermit' 4a C —
.�f gra `'We are unable It, Locate a yand pen-ru for the work being don p 4 D z
required for,this project::Work°SHALL NOT conttriize until a permit has been obtainedrFFFF
FILLT and;.the work inspected for coriformance:with'appltcable codes ,and ordinaif nces If;;you u�
3 F O
(j �<FIX
ave, already obtatnedthe ermit,,please`contact us'at (425) 771-0220,:wrth the;permrttL "` -�
(1 {ifs , 1't fYGYi�at22f) f�n:: .:.+ - :J. R f ;4� Nf,.�.. L t. 1 ..I:a ! '.5.r - l J r+
li ✓`�;i �J a j♦YVi ly a.,.. .�...`i.' a: 1r1'lit L'fa 1 r y,< -a V1rL4 Yr a-
_fFLN number so.,we can revise our records f4 lr , ,< �,x_>,
aeV{J"7�i • Jr41e t ,-j i ') ! :' < •b, w 4 -�� l e 1 ) Ya. m
l t 1 'r: r ^F 1 {: e qr ,... r -;,r ')q. rn
4 {.+ d ro lr,, , 11 'c• r r -f r l t r 5 , t
t r f ar 1 t{ x 1 '.< a r ( 7 1r, !� 1 -r.t 1 �a 31 r�r l Y. :f1J yr v
yjej yy \1 dt i:.r Cn
LI
'�1t : t ! :r
ti• X511 ':x;';•: a t J'dt�'•ti , 'i J... ✓ c i• r a7 - !. ., �: } 1 f il!-��4r �•tr ..._ • •! .(.• •:. r •t4 ({{"7`�i, • ` 1 !} '2ap:•j1's!r
{ j•i.r, "» t i`C�ry�, 1 '• '•� _.t. �., ,... ora:��res �onse ><n'wr><t><n f3r:.1,±:Y L I, 4t '� O r
a. Y ;,An application must be submitted y,, , ,��,: 0 m
r r�l lya(Itlf.7,-r, x:: . r F. t r S..'Yr TL? ?.. T x L.' r.
slyrFE1t 1StPA4 t., ..t� ,,...�-'^f'', .fft,,.. C t: +... .:C, :1; 1r�:�.,,i r'^
-imust be made toour'office no later than 4.00 pm onCn
y _ J , ill Lt r
s sL a z r
.A VIOLATION FEE EQUAL.'ORUP .TO FIVE TIMES D
THE PERMIT FEE SHALL BE ASSESSED.
K.�gbr t i,; {:' J7 1� j: r'A J - f r ?r Posted.t11is t Li GLV O1 i.r F r 1 .S r t h'F...'I I dr J.JF lj y'^
I P.En
t :, t! i Y v r t_ ° Z
G , f
Y- I l a f _ x f Q I -
BUlldlll fficial
€�; V �Varnin: The failure to stop this work or activity 'and/or the
�` resuming of -work without permission or the removal,
mutilation, or concealment of this Notice is punishable.by'fine
and imprisonment.
City of Edmonds Development Services Department Building Division
RK
121 5i1i Aire N • Edmonds, WA 95020 • (425) 771-0220
Office flours M -r 9-12 and 1-4
i•