20050878.pdfDATE RECEIVED Cf�i Y
PERMIT EXPIRES
CITY OF EDMONDS NUMBIER
CONSTRUCTION PERMIT APPLICATION ooREsB, SUITETAPTa
OWNER NAME/NAME OF Bt}fS`INESS 1'171 ` t • C ` - '*1
G f `�' V �- C� Qi1 cS . PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
WU MAILING ADDRESS ` . LID FEE 5
�}PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved [3,� , \ IM , r {a, ` RW Permit Req,urexl [3
Street Use Permit Rewred ❑
CITY ZIP TELE HONE EXISTING PROPOSED _ inspection Reowwd ❑
p. Sdowalk Repueed ❑
Yil(� 1'1cX S 20 '� ! U C. REQUIRED DEDICATION _ FT underground ❑
Winne r cored ❑
NAME METER SIZE LINE SIZE 1'77070F FIXTURES PRV REQUIRED
10- 1YES D NO 9
U it
= ADDRESS —� REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
it
i W
CITY ZIP TELEPHONE �- i
2
NAME, p ( CBBLL# -^
L a n aw J� ��/ t ��"� �/3 VcJ y E INEERING REVIEWED BY i DATE
0: ADDRESS 1
Ave, So,A
RE REVIEWED BY D AE uJ
�
CITY ZIP TELEPHONE
STATE LI//G,j�EN((S��E/�NUMBER ' {1�) EXPIRATAIO'N DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
L /�7 1 D A A +• '" •! 1 bt4�Y x REO',300N CO PL T.D EXEMPT
V OYES Lir NO WS
CAq ^' ZON SIGN AREA HEI HT
PROPERTY TAX ACCOUNT PARCEL NO. - ( j
,nn,'nn U �cn� ^/ /j/�� WAIVER O R' /M./ry ALLOWED PROPOSED ALLOWED PROPOSED
W el 2?? CJ ,/ - 1 tl/ � O'er � rJ STUDY
❑ NEW ❑ RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR O
COMMERCIAL �`j COMPLIANCE OR z
❑ ADDITION ❑ MIXED USE El CHANGE OF USE _
PARKING LOTAREA PLANNING REVIEWED BY DATE a
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED %%Llf'�i
❑
GRADING ❑ FENCE Na �� REPAIR ❑ CYDS ( jX� FT.) REMARKS r WA` ^ 7_ 0 4u ;+►off i�
❑ DEMOLISH ❑ TANK d OTH eLr Yl 1 �jswot
k
GARAGE RETAINING WALL FIRE SPRINKLER YJ, n r to kyr
Z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
A (TYPE OF USEy BUSINESS OR ACTIVI Y) EXPLAIN: Ito V
ptt. Z3' S 40• .
FE r I�1 t I O �4e I a TYPE OF,C�ONSTRUCrTIOtJt o
GROUCCUP
GNUMBER r jiii NUMBER OF IIJar f\ t n ILo•11
OF DWELLING SPECIAL iNSPE ON CONSULTANT OCCUPANT
p STORIES NA UNITS LOAD
0 REQUIRED DYES
DESCRIBE WORK TO BE DONE nn
V'L OLVIS. Si'fj REMARKS
GEOT
BY: JifT71AJf?7,
je9 hr\ Q ri &d the iffial zLr" LV STRUCTURAL DESIGN
VALUATION
S�o r 2, nce a, r Gni $
Description FEE Description FEE
Plan Check ��)' State Surcharge
HEAT SOURCE�7 LOT SLOPE% VESTED DATE
Building Permit City Surcharge T
PLAN CHECK NO: �t_ f ` Plumbing Base Fee `
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. T IS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION.ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
� Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. IRSpeCllOn
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOVne
iew Plan Chk. Deposit y
Uj Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY ANection Receipt e7
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT
X FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT 4z
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANpe Insp. Total Amt. Due J
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIO
ng Fee Receipt # 41
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATIOAPPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OThis application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYEreceipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TNSPECTION
WOR3pfq COMPENSATION INSURANCE AND RCW 19:27. FCIA SIGME DATE
SI NA (OWNER OR G ): DATE
%SIGNED •� (425) r r
/ 71 -0220 ELE D B /D E
ATTENTION EXT. 1333 LC
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -IL YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110. PINK - O GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
I
Z
t 0
M
'
Cf
m
C
M
O
On
C
I�
=m.
mZ
lO
�
r
N
I
Z
t 0
M