20050890.pdfDATE RECEIVED
1�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF B SINESS
C Ck 5ti S -fu C e
MAILING ADDRESS
a36osa Ow y
ZIP TELEPHONE
�c3�5 8() 6 (t2 �k3 25-
ADDRESS
TELEPHONE
<l �� I I PERMIT EXPIRES
PERMIT PERMIT � ,�.,�- .0 no ;�
NUMBER �(�� `��', L)
JOB / SUIT P n
ADDRESS ,I ✓�
1�q
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP
RW APnit ro ed O
Street Use Perrin Required
EXISTING —PROPOSED inspection Required O
Sidewalk.Roqueed CI
REQUIRED DEDICATION FT Underground O
Wiring ro cared 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
w
REMARKS Lit
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
z
Lu
L '
v AJ,,�L �I (U ENGINEERING REVIEWED BY . DATE
o: ADDRESS
U
FIRE REVIEWED BY DATE
~ CITY P TELEP ONE it
puo� Vfj(4UV0E3V3j , 6bo_ 4 �Zq 2 S�
STATE LICENSE NUMBER EXPIRATION DATE 211FCKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
e % A REQ'D COMPLETED EXEMPT
��'S s V��C V / % Ast4wrk A i�ES ONO ✓
CA# YA ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
WAIVEROC
ALLOWED PROPOSED ALLOWED PROPOSED
/ [, / r STUDY O C �./ �' Z r itr�.
NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMMERCIAL COMPLIANCE OR ALLOWED
ADDITION ❑ CHANGE OF USE �q
MIXED USE Nq _
PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY SIGN REO'D PROVIDED a
c
❑
REPAIR
GRADING FENCE ,N t L ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ElTANK ❑ OTHER
RETAININGGARAGE FIRE LER
z ❑ CARPORT ❑ RO KERY WALL ❑ FIRE ALARM
n(TYPEF USE, USINESS ORACTIVITY) EXPLAIN:
�((S��% TYPE OFrogNSTRUCTION CrrDE� GROUPom
ANT
o
NUMBER NUMBER OF
OF DWELLING /) .� SPECIAL INSPECTION CONSULTANT OCCUPANT
M STORIES UNITS v LOAD
REQUIRED CI YES
DESCRIBE WORK TO BE DONE
REMARKS z
GEOTECH REPORT �
• BY: m
STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check , State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit J City Surcharge
PLAN CHECK NO: ._. Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOT D. THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
w
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engf. RBVIBW
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
y
*APPLICANT* ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
UJI IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # t7 I
a 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 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 This application is not a permit until signed by the
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 CALL Building Official or his/her Deputy: and Fees 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 COMPENSATION INSURANCE AND RCW 18;27.
OFFICIALS SIGN T 'i DTE
S NATURE (OWNER OR Nf): DATE SI _ (425) ` 7 i�(t ��/ �� `� i
` V 771 -0220 'R'FL —2 `b BY 7 D E
ATTENTION EXT. 1333
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 / IBC110 I IRC1100 PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
I