20050883.pdfDATE RECEIVED To / 0 S [ PERMIT EXPIRES
�A��j
-]
PERMIT CQ
CITY OF EDMONDS NUMBER W�
ADDRESS
CONSTRUCTION PERMIT APPLICATION JOB 9//0 r?, �LTEIAW�#
OWNER NAME/NAME OF BUSINESS' (
/?y 5'ir� 47:� z4v.'r C� / L/ lir PLAT NAM DIVISION NO. LOT NO. LID NO,
I
MAILINGADDRESS f LID FEE $
;57' PUBLI OR IESCPAppro�ed
Street Use Perind Required [3
CITY ZIP TELEPHONE EXIST qG
rT4;Z I SMMMMIJ i" D
REQU RE[f.OEblcl�Yl�.b� V".','4 f"R (-FT d
V4 vinAl
411altilt
d
NAME
MEI:R�fzf*l:,�
f IX TW RjFjtPN�
ffOUVIEff, F,
ADDRESS
REM
OWN
K 7'N 70" -ir
RICONT46rok RE SPONSISX FOR EROSION.CC)tiTfR5F�itRAgr�,'j�'. 1V '143
MATErl,To%
. V S (Upc
CITY ZIP
TELEPHONE
t 7 Zf Itt
NAME
CEIL
AUfE,,.ED P T1
ENG
EER ING REVIEWED BY) A D F) F D C(-)�,-r"DATEI,
Z,!� Ijj
f_A CA I
ADDRESS
,joy
>
FIRE
�E`AiWE DATE
CITY ZIP
TELEPHONE
L.P125*
1
z
0
_ .
I
C4. 9-,V -1 C
z 2 C,- , 0 e? 7 4-t.
0
AN E OR CU
SHORELINE ORADBJI
1
I INSPECTION
REQ D
SEPA
CONWILETED EXEMPT
EXPIRATION DATE
STATE LICENSE NUMBER CHECKED BY
j 61 -
01 12 X )" 41 49 0 15 Z! zz q /0 6)
13 YES C3 Nol
I
M
CA#
WAIVERE3
ZONE
SIGN AREA I
ALLOWED , PROPOSED
HEIGHT
ALLOWED , PROPOSED
PROPERTY TAX ACCOUNT PAP.EL NO
.2�)` 06q��0300
STUDY 13
M
C
NEW RESIDENTIAL q,,PLUMBING MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
L
ADDITION E] COMMERCIAL LIANCE OR
El
z
E
z
0
IT! 0
.-1
CHANGE OF USE
MIXED USE
0
0 C= I
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
5
REMODEL MULTIFAMILY El SIGN
REO'D PROVIDED
06
--1 C
X M
GRADING FENCE
REPAIR CYDS x FT.)
M z
JO -1
REMARKS
11 DEMOLISH E] TANK OTHER
C 2
-1
GARAGE RETAINING WALL FIRE SPRINKLER
x
CARPORT ROCKERY FIRE ALARM
q -n
X
M M
(TYPE OF USE BUSINESS OR ACTIVITY) EXPLAIN:
ITTYPE
��q 5; t 4d le JL t
OF[Vg(TION
COG
OCCUPAjf?r 3
GROUP f <,,,,
NUMBER
OF
T7NMBER OF
U
U
DWELLING
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
STORIES 0 /f/
UNITS
REQUIRED
LOAD
0
DESCRIBE WORK TO BE DONE
0
X k041 40
REMARKS
z
0 M
C Cl)
M 0
Z
ic, 7 '-ro- (Le- r 7'-cj- 7A le
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
X
—4
3:
>
it -.e ie- c-
VALUATION
$
J
C
z
Description
FEE
Description
FEE
V oTa/ e-e
z
0
i
0
M
- - - -
Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPET
FVESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
f�
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0
'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
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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC E
Landscapelnsp.
Total Amt. Due
h".)
? NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
APPLICATION APPROVAL
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
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
CALL
Building Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in pace provided.
OFIF S
DA E
WORKMEN'S COMPE���NCE AND RCW 18:27.
(425)
SIGNATURE (OWNER AG�INT),.:
DATE SIGNED
7 01
:
IL
771 -0220
'-RELEASED
13�
DATJ
ATTENTION X L 1,J,5.3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
z
ENGINEERING DIVISION DATE
0
M
PLANNING DIVISION DATE
=n
PLEASESIGN
M
PROJECT—AgJ-0-1
M
0
SITEADDRESS. 611
0
PERMIT ADB# DATE INSPECTED
M
M Z
CE
DESCRIPTION OF WORK TO BE INSPECTED
3:
A fie e with Final approval
Id inspection was conducted to determine complianc -approved plans.
0 -n
-n
denotes that there are ..no objections . from the above signed Department to the release of
X
M M
PERFORMANCE BONDS and the granting of:
0 Fn
0
0 M
C (n
9 Cn.
GRANT. FINAL PROJECT APPROVAL
Q 0
z
GRANT PROJECT APPROVALWITH CONDITIONS NOTED
Cn
El Copy of CONDITIONS givento owner/contractor by inspector
z
0
M
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fornis:ocaprv1 3/25/04