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20050911.pdfDATE RECEIVED J PERMIT EXPIRES !' CITY OF EDMONDS ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTN ADDRESS ! 11 l I �a;"t�,��• OWNER AME/NAME OF BUSINESSV A L.� PLAT NAME/SUBDIVISION NO. LOT NO. LID O. /I 1i MAILING ADDRESS ✓I I LID FEE S TESCP Approved 13 w PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required El Street Use Permit Req'd p CITY 21P TELEPHONE EXISTING PROPOSED inspection Required O Sidewalk Required r/, plpm /:I REQUIRED 1�Zs��/'-5/y5 REOUIflEDDEDICATION FT Underground �(//((// if v D U idnrgroun rod p NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED t7 4P.:✓ "yr a.,, •�F" YES❑ NO E3 u ADDRESS REMARK §" r . Z c OW O ., F �e ^ OROL/DRAINAGE CITY ZIP TELEPHONE r` ALL NOT W BE AUP1.13TED NAME ^�� CAlAt01� �J/ ENGINEERING REVIEWED BY DATE = ADDRESS 4% IPA FIRE REVIEWED BY DATE W CI ZIP TELEPHONE �c-t- �iea r yzs- LL VARIANCE OR CU t SHORELINE OR ADB# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CH CKED B hLU • "-"PASTED 6745aA A03063z 7 g• SEP k REVIEW SIGN ARE�Ap�pg4 HEIGF PR/O�P,EERRTYY�TAX ACCOUNT PARCEL NO. COMPLE T ( t1�1�lEq I IG11i31b 'OWED ROPOSED J Vt.'c—'7. �Z�OQC©O'ZQO EXP �........... ...,�...... ..... .- 1 NEW RESIDENTIAL �PLUMBIN /M( LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7 COMPLIANCE OR z ADDITION COMMERCIAL ❑ CHANGE OF USE Z PARKING LOT.AREA PLANNING REVIEWED BY DATE . a REMODEL 13 MULTIFAMILY SIGN REQ'D PROVIDED REPAIR GRADING PENCE CYDS X FT)REMARKS DEMOLISH TANK OTHER = DGARAGE RETAINING oFIRE CARPORT ❑ ROCKERY WALL FIRE ALARM SPRINKLER 0 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: a CHECKED BY TYPE ONSTRUCTION Coj�E OCCUPAN v / 1 GROUP oNUMBER NUMBER OF CRITICAL lVJ OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT MSTORIES UNITS NUMBER (Iv �Rll REQUIRED LOAD YES DESCRIBE WORK TO BE DONE REMARKS 0 PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9 �0!I��LT3 /�t/Gt.,r/OES bi A5 i>pING U Q S GusTY-E9s VALUATION Description FEE Description FEE OZL Plan Check State Surcharge HEAT SOUR E GLAZING % LOT SLOPE %/ Building Permit City Surcharge , PLAN CH VESTED DATE Plumbing Base Fee 60 THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Gradin 7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 9 SEPARATE PERMISSION, Engr. Review W PERMIT APPLICATION: 180 DAYS CL PERMIT LIMIT. 1 YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION (n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # 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 0i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandSCap@ Insp. Total Amt. Due = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.% Recording Fee Receipt H 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 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALLThis application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 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 rqEHIplis acknowledged in space provided. WORKMEN'S COMPENSATION RANCE AND RCW 18.27. OFE DA SIGNAT E R OR AGENT) DATE SIGNED [�-� OS (425) F S SIG I rb 771=0220 RELE SE BY DA[E ATT I N EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIG AILJ FILE YELLOW INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINKOWNER GOLD -ASSESSOR 0903 PRESS HARD -YOU ARE MAKING 4 COPIES 0 M Cn cIn M 0 On C mZ Q � DZ r= 0 M11 mm I, oN 0m C Z r OMNIN I 1P Z o SEEMEDS 0 SINNIn M