20050945.pdfDATE RECf~VJED
PERMIT EXPIRES
dE PERMIT
CITY OF EDMONDS zONE NUMBER00 a -C)`��
CONSTRUCTION PERMIT APPLICATION JOB UI E/APT#ADDRESS
OWNER NAME/NAME OF BUSINESS
rye�1.1 . S (W (A u 1 'j�j'j� (� PLAT NAMEISUBDIVISION NO. LOT NO. LID N0.
s MAILING ADDRESS LID FEE S
Z Approved
30 3O arIe� RW Pe PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RY! Permit Required I[]]
Street use Permit Req'd
CITY ZIP TELEPHONE - EXISTING PROPOSED Inspection Required (]
T \ /� ^ Sidewalk Required 13
WM6�V� lJ[�� -�5�•���Ll �qr� REQUIRED DEDICATION FT Wiring
L I J widUnder round O
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED t,
f YES ❑ NO ❑ Q
U w
ADDRESS REMARKS z
_ OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z
U
sa w
CITY ZIP TELEPHONE
NAME
061ZEK k 4Tk \L.A/b CBL ( , j ENGINEERING REVIEWED BY DATE
ADDRESS Lit
41oo 1 5 13q- T4j T i.
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE M
U Mi CSI' 0t6A q$l!e Y ���.o1'�Y'-�`lDb -
LEXP
OR CU SHORELINE OR ADB# INSPECTION BOND
STATE, LICENSE NUMBER q w-� �L EXPIRATION DATE CHE XDY REO'D POSTED
�'1 1 �1 OYES ONO S
EVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCCQCODUNT PARCEL
�NO.
` EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
uj DO54O 410 0 V oo I
❑ NEW RESIDENTIAL LUMBIME H LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMPLIANCE OR z
❑ COMMERCIAL ❑ CHANGE OF USE _
PARKING LOT AREA PLANNING REVIEWED BY DATE a
❑ REMODEL ❑ MULTIFAMILY SIGN REO'D PROVIDED
❑ REPAIR ❑ GRADINGCYDS ❑ (ENCE X FT) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
_ ❑GARAGE RETAINING FIRE
CARPORT ❑ ROCKERY WALL ❑ FIRE ALARM SPRINKLER
O (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Q svlz�CHECKED BY E OF ON Tj�1%TION CODE OCCUPA T
t7 ►J ()"2)
GROUP
v.NUMBER, NUMBER OF CRITICAL 7
OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
OSTORIES UNITS NUMBER REQUIRED YES LOAD
DESCRI E WORK TOBE ONE
aip REMARKS
c uAu �/Y1 PROGRESSINSPECTIONS PER USC 108/IBC109/IRC109FINALINSPECTIONREO'D 9
V- 1IJ �DWNxSTA(Rb
&ACc, LO OP�AIQLq VALUATION
Ut)tP $
i5 Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing 140 Base Fee
Mechanical.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0 0 -
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Gradin
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g I
SEPARATE PERMISSION. 1
M Engr. Review ,
CC
Lu 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
y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review EEIM.Deposit .
9 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 Landsca a Ins Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P p
=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
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 TH RK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE(LAB0R%C.,0DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENVrl'OWMSDOANCE AND RCW 10.27.
O;SED
A E TE ICE
S RE (OWNER R AGE DATE SIGNED 10e%;�
.y(425) \'141W 1 1" 11 771 1 =0220 RY (JD TE
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW -INSPECTOR
PANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC1'10' PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD =YOU ARE MAKING 4 COPIES
O �1
'n
� D
mm
O rM
r
rb 0)
r Z0
74 1T1
W
a
t z
Z
z
O
n
M
z
O
0
M
�r
�'Mq
c
M
my
O
--1
OC
=M
M
A�
C
r
z .
�
O �1
'n
� D
mm
O rM
r
rb 0)
r Z0
74 1T1
W
a
t z
Z
z
O
n
M