20050952.pdfI
DATE RECEIVED
I CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER IWE/NAME OF BUSINESS
MAILINGAODRESS
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[PERMIT
EXPIRES
PERMIT '11,
NUMBER r
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ADDRESS
SUITE/APTP
PLAT NAME/SUBDIVISION NO.
LOT NO
LID NO�
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIPApproved
RW Peml Roquved
EXISTING PROPOSED
Street Use Parred RequirLci
Inspoclion Required
REQUIRED DEDICATION FT
Sitiawalk RiNuired [3
Uicierground
MET ER IZE
L114E SIZE
NO.4 F,XTURES
F RV REQUIRED
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OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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EERING REVIEWED BY
ZIP TELEPHONE FIRE REVIEWED BY
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DATE
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DATE
STAT ICENSE NOMBEFC EXPIRATION DATE C BY VARIANCE OR CU SHORELINE RADB# I INSPECTION I SEPA
REO'D COMPLETED I EXEMPT
13 YES Y�,NO x
PROPERTY TAX ACCOUNT PARCEL NO. CAN 1/00 ZONE SIGN AREA r HEIGHT
4A. () G 0 a WAIVER [3 ALLOWED OPOSED ALLOWED PROPOSED
4�� &2RI 0 STUDY a _ I PRO 1 7_.F 1 1 7_41
)�rNEW RESIDENTIAL LUMBING I MECH LOT ERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWECDOVPROPOSED FRONT SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR E5 (ilkl 6�4e-elll 10 4.5
MIXED USE CHANGE OF USE
REMODEL PARKING LOTAREA, PLANNING REVIEWED BY DATE
[:],,MULTIFAMILY SIGN REO'D PROVIDED
REPAIR G3M C FENCE 1 1 -7,. 1 1
YDS x FT.) REMARKS
El DEMOLISH TANK E] OTHER
'--'GARAGE
EiRETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR C �CITL\� LAIN:
I P� RUCTION OCCUPANT
NUMBER NUMBER OF GROUP
,e 73E
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED 13YES CIE I
REMARKS
GEOTECH REPORT
BY:
q7— STRUCTMAL �ERG
BY
VALUAMON
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Description
HE^-OUReE LOTSLOPE% VESTED DATE
Plan Check
Building Permit
PLAN CHECK NO: 7
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
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Engr. Review
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
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Fire Review
Fire Inspection
Landscapeinsp.
Recording ee
--- 111111111
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S C#",n SATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771-02 0
SIGNATURE\&NYOR AGENU.4
DAT E.SIGNED
C.
FEE
Description
FEE
State Surcharge
0111
City Surcharge
Base Fee
yl�
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Plan Chk. Depositl
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a pernut until signed by the
Building Official or hes1her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
I I S SIGNAIU E
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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- OR NAL -FILE LLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110. JNIK -OWNER MOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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2250 Act al
Edmonds Wa. 98020
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GRADING CALCS Vfr in
CUT -3-5-5.yards 944 Maple Street
70 Yards
SEP 20 200 FILL Edmonds Wa. 98020
-TfTY C 0-"" w'%Y Ph: (206) 498-5339
SITE PLAN
,E&JI*LDING DEPARTM NT
CITY OF EDMOND Total Cut/Fill 7 425 Yard' Scale: I hich 20 Feet
Hei lit Calculation Worksheet
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HNAL PRO.1 , APPROVAL 1"401INI
MEMO TO: PERmrr COORDINA'.FOR, BUII,DIN(! DWISION
FR0,1\4: —FIRE
PLEAS17 51 "N'
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DESCRIPTION 01,
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N field inspection wa*s conducted. to. determine compliance wit.11 approved plans.
al approval.
Fin.
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denotes. that there are no objections from the . above signed Del) I 11(
the release of'
PERFORMANCE BONDS and the granting of:
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GRANT FINAL. PROJE CT APPIZOVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy. of CONDITIONS given to owner/contractoi by inspector
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Copy of CORRE4 MON NOTICE given to owner/contractoi--by inpectol,
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RE-INSPE-CTED OuTsTAN-DING ISSUES - GRANTFINAL PROJECT APPROVAI.,
Date SignatUre
I:t.enip:bldg:ronils:ocai)rvi.3/25/04