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20050891.pdf40.1 DATE RECEIVED e CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS /n!/] G//%n`��1 v �'/ �W I w MAILING ADDRESS CITY ZIP TELEPHONE 'Vr NAME L) W t ADDRESS CITY ZIP TELEPHONE NAME �n1v I Ar V M (I ko CBL# PERMIT EXPIRES D 1,4 PERMIT 67 JOBNUMBER C%�k�'�•�� 0 / JOB SUIT' PT#. ADDRESS?.. PLAT NAM EISUBDIVISION NO. LOT NO. LID NO, LID FEE 5 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 13 RW Permit Required C Street Use Permit Requited L3 EXISTING' PROPOSED Inspocaon Required E3 /Sidewalk Required 13 REQUIRED DEDICATION FT Underground O Wmn r w+od 17 METER S1ZE LINE SIZES NO. OF FIXTURES PRV REQUIRED / �✓ YES O NO O z REMARKS tu w OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJDRAINAQE z z •.._ CSL, � � � ���;4-r�-v� �Jn l "' HFIREREVIEWE7D EVIEWED BY DATE ADDRFcc If\ i- Volo ._PM ` a "i BY DATE i Cr I TELEPF r i �--- VARIANCE OR Cu SHORELINE OR ADB# INSPECTION SEPA STATE LICENSE NUMBER EXPIRATtnki ^"Tr -• • �•.cn nv REQ'D COMPLETED E%EA1� / � OYES NO tiIF PROPERTY TAX ACCOUNT PARCEL NO. CA" ZONE SIGN AREA HEIGHT J i ST IVER O '[Z �° 000 _ ALLOWED�� ,� ALLOWEDPROPOSED ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING ! MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED kTBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR �Q COMMERCIAL COMPLIANCE OR ❑ ADDITION rf"'o ❑ CHANGE OF USE ❑ MIXED USE ❑ REMODEL ❑PARKING LOT AREA PLANNING REVIEWED BY DATE MULTIFAMILY GN REQ'D PROVIDED )A `r ❑ REPAIR ❑ GRADING CYDS >—Call NCE7 4J ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER ❑ CARPORT ❑ ROCKERY RAGE RETAINING WALL ❑ FIREALARM FIRE LER (TYPE OF USE, BUSINES5oqR ACTIVITY) EXPLAIN: TYJ OF C�Ot�S RU TION DE GROUP NUMBER L - NUMBER OF C�wJL/(/J�^ OF DWELLING /1 I SPECIAL INSPECTION CONSULTANT OCC ANT STORIES UNITS / V` LOAD, REQUIRED 0 YES DESCRIBE WORK TO BE DONE REMARKS GEOTECH REPORT' BY: STRUCTURAL DESIGN BY: VALUATION $ Description FEE Description FEE Plan Check " Stale Surcharge HEAT SOURCE LOT SLOPE%a VESTED DATE J Building Permit `— City Surcharge C PLAN CHECK NO: - �� Plumbing Base.Fee D5 625 THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review u 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 Engf. Inspection •APPLICANT, ON BEHALF OF NIS 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 ORDINANCE Landscape Insp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee. Receipt # y i 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 IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLA N OF THE LABOR E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided. WO N'S CO ENS T N IN NCE AND C 8:27. FFI S SIGNATOR DTE Ek N DATE SIGNED (425) Z i I , O n m C my O z OC 5 mZ 10 AZ 0) =n mm vN nrn m rb Cf) 1' o a Z 0 m Z 0) Z O 1 Lil �: •a �- r l�' -� 771 -0220 w1kEL ED BY DATF Ir 1 ATTENTION EXT. 1333�0 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL� A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- 0GINAL -FILE LLOW .INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110. INK OWNER G LD • ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COP,