20050930.pdfDATE RECEIVED
r I PERMIT EXPIRES --1t I I.`.l•-�iG,
PERMIT
CITY OF EDMONDS ZONE NUMBERU,�J
CONSTRUCTION PERMIT APPLICATION
JOB t�/ ^.UITE/APj#
ADDRES,.• V`�O� �/1).'l/I%1� `4j
OWNER NAMEINAME OF BUSINESS �,r—�j .r(/ �f ��, 0i
^ TTOA) j���. •��/ ' Mass
PLAT NAME/SUBDIVISION NO. L6T NO. LID NO.
W MAILING A(►DDRESS ' 1 / LID FEE $
13
3 9 4 • j11v 'FLA
' /L c � PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PP Approved
� v I"" r•i, �•'i.� RW Permit Required
Street Use Permit Req'd
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required 13
Sidewalk Required
S r1 1(�( REQUIRED DEDICATION FT Underground
b 1 " cI6, �� — I (!�►,v Widng required E3
NAME METER SIZE LINE SIZE NO. OE FIXTURES PRV REQUIRED
j A«
�S (1 610 WN YES ❑ NO ❑ Q
W
ADDRESS REMARKS i
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CON L/DRAINAGE r W
CITYZIP TELEPHONE
oS
NAME - CBL N
AM
E G EERING REVIEWED BY ffff�C DATE
ADDRESS f,
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FIRE REVIEWED BY DATE W
CZIP TELEPHONE cc
(01 EM
STATE LICENSE NUMBER EXPIRATIO DATE H ED BY VARIANCE OR CV SHORELINE OR ADBM INSPECTION BOND
RE POSTED
'. ❑YES NO $ f
SEPA REVIEW SIGN AREA HEIGHT
PRO RTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
el
003 0
3 0�� EXP
NEW RESIDENTIAL PLUMBING ( MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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ALLOWEDpgOPOSED MTm
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❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR 3 5/, 2 I ,�*O
CHANGE OF USE J . . _
LREMARKS
NG LOT AREA PLANNING REVIEWED BY DATE n
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN ROVIDED '# / �-�
FENCE 3 q9 Z4 02; /1-10l OC7
❑ REPAIRGRA CYDS ❑ (
�0�. X :FT)
❑ DEMOLISH ❑ TANK ❑ OTHER
Sr=vjoGARAGE RETAINING WALL. FIRE SPRINKLER
G CARPORT ❑ ROCKERY ❑ FIRE ALARM
g (TYPE dF USE, BUSINESS OR ACTIVITY) EXPLAIN:
s Si d y/ Kb CH CKED BY I TYPE OFC N LICTION CO GROUP
AN
V rl ►� `
nNUMBER NUMB R OF CRITICAL (�
OF DWELLING AREAS tJl SPECIAL INSPECTION JAR hC OCCUPANT
OSTORIES UNITS NUMBER ( REQUIRED ❑YES v� LOAD
DESCRIBE WORK TO BE DONE V 1412
REMARKS _'
PR OGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D 9
S 2 a �u,me4tL Dy K0110 Fo/05031
Ilia o-,�
`Z I /�1 y " VALUATION
`ws� s .. d $ 3b a6
Description FEE Description FEE
' �� '� cJ'L(-C� Plan Check a .� State Surcharge0q 05)
HEAT SOURCE GLAZING % LOT SLOPE %
j%0y, Building Permit b City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing f Base Fee g
Mechanical 7
THIS PERMIT AUTHORIZES ONLY THE RK NOTED. THIS PERMIT COVERS WORK TO
i= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
It: SEPARATE PERMISSION. In
Engrg
W PERMIT APPLICATION: 180 DAYS
4 PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection j7
SEE BACK OF PINK PERMIT FOR MORE INFORMATION w/
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit a
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 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 N NO
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- CALL This 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 Foes 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 COMP NSATION INSURANCE AND RCW 18.27,
OFFICIALS SIGNATU OAT
ST ATURE WNE OR AGENT) DATE SIGNED (425) ,. t � f
0. 771-0220REL BY
`J
D DATE
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109 / IBC110/ IRC110, OR K FILE • YELLOW • SSEISS R
OR
P K•OWNER GOLD -ASSESSOR ^
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