20050972.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITYZIP TELEPHONE
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NAME
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STATE LICENSE
NUMBER
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L �� PERMIT EXPIRES
PERMIT
NUMBER -�`7 r
JOB SUITEIAPT#
ADDRESS S q
PLAT NAMEISUBDIVISIION No. ! LOT NO LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Required
Street use Permit Requited
EXISTING """"' • •'PROPOSED, Inspection Requited
ay "• Y' k f ti S" t'I `i Undor rounp
REQUIREDDEdICrTION _�Qi171 v0'oJimnirs
METER SIZE L N f51IL� �l; •(�74F11idS)(1f�U� in FtV REOUIR
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REMARKS �,�
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRATRRGE'
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FI BI`.:i; & Industries D E LU
ZIP TELEPHONE
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EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE ORADB# INSPECTION SEPA
r % //) %� 9 REO'D COMPLETED EXEMPT
J �/ L ( // ! OYES 0 NO
CA# ZONE SIGN AREA HE
ARCEL NO.
` � �: � //��j Jl WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
(��{ 6 v STUDY O
W RESIDENTIAL PLUMBING LOT COVERAGE REQUIRED SETBACKS (FT.) IPROPOSED SETBACKS (FT.)
�'1 ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIALz
COMPLIANCE OR O
MIXED USE ❑ CHANGE OF USE Z
PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ GRADING❑ FENCE
CYDS ( X FT.) REMARKS
❑ TANK ❑ OTHER
❑RETAINING WALL FIRE SPRINKLER
ROCKERY ❑ FIREALARM
IR ACTIVITY) EXPLAIN: ^
GJl I TYPE OF STRUCT N COD OCCUPANT •�
GROUP
NUMBER NUMBER OF � b3l
OF / DWELLING / SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS ` LOAD
DESCRIBE WORK TO BE DONE REQUIRED YES
(� ' (^ �7 REMARKS z
InsJ I`/ I cN6 04 % �_// ` � �/ GEOTECH REPORT m
!re 1 K BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURC LOT SLOP % VESTED DATE
Building Permit City Surcharge
PLAN HECK NO: Plumbing Base Fee
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
J SEPARATE PERMISSION.
E Engr. Review
U
PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
u IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I 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 #
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- CALL Building Official or hislher Deputy: and Fees are paid, and
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 FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION URANCE AND RCW 1827, OF ICTAL SIGN U E ATE
SIGNANER Z DATE SIG(425)T 101
z
`G rl
7710220 RELEA E B ATE V
ATTENTION 7 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• ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110, PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD m YOU ARE MAKING 4 COPIES
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❑ NEW
❑ ADDITION
❑ REMODEL
JZ
❑ REPAIR
❑ DEMOLISH
GARAGE
❑
CARPORT
(TYPE OF USE, BUSIN
YiI:111:11aue 0:1
r..
L �� PERMIT EXPIRES
PERMIT
NUMBER -�`7 r
JOB SUITEIAPT#
ADDRESS S q
PLAT NAMEISUBDIVISIION No. ! LOT NO LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Required
Street use Permit Requited
EXISTING """"' • •'PROPOSED, Inspection Requited
ay "• Y' k f ti S" t'I `i Undor rounp
REQUIREDDEdICrTION _�Qi171 v0'oJimnirs
METER SIZE L N f51IL� �l; •(�74F11idS)(1f�U� in FtV REOUIR
t.3ro gh U1111(:14t , s aces. t' Y $ No
REMARKS �,�
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRATRRGE'
Z
a
w
w
z
z
Lu
/ r.c.�Y V� EN t:RIWQmR&W1nlAIr0 .....e.....+.....�........� .GATE
�c� ObWrt Electrical Permit fIrm
FI BI`.:i; & Industries D E LU
ZIP TELEPHONE
IL
EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE ORADB# INSPECTION SEPA
r % //) %� 9 REO'D COMPLETED EXEMPT
J �/ L ( // ! OYES 0 NO
CA# ZONE SIGN AREA HE
ARCEL NO.
` � �: � //��j Jl WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
(��{ 6 v STUDY O
W RESIDENTIAL PLUMBING LOT COVERAGE REQUIRED SETBACKS (FT.) IPROPOSED SETBACKS (FT.)
�'1 ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIALz
COMPLIANCE OR O
MIXED USE ❑ CHANGE OF USE Z
PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ GRADING❑ FENCE
CYDS ( X FT.) REMARKS
❑ TANK ❑ OTHER
❑RETAINING WALL FIRE SPRINKLER
ROCKERY ❑ FIREALARM
IR ACTIVITY) EXPLAIN: ^
GJl I TYPE OF STRUCT N COD OCCUPANT •�
GROUP
NUMBER NUMBER OF � b3l
OF / DWELLING / SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS ` LOAD
DESCRIBE WORK TO BE DONE REQUIRED YES
(� ' (^ �7 REMARKS z
InsJ I`/ I cN6 04 % �_// ` � �/ GEOTECH REPORT m
!re 1 K BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURC LOT SLOP % VESTED DATE
Building Permit City Surcharge
PLAN HECK NO: Plumbing Base Fee
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
J SEPARATE PERMISSION.
E Engr. Review
U
PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
u IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I 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 #
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- CALL Building Official or hislher Deputy: and Fees are paid, and
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 FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION URANCE AND RCW 1827, OF ICTAL SIGN U E ATE
SIGNANER Z DATE SIG(425)T 101
z
`G rl
7710220 RELEA E B ATE V
ATTENTION 7 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• ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110, PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD m YOU ARE MAKING 4 COPIES
0
0
M
'i mn
vM
co
M
CI C
im
M
10
�Z
Cn
O wn
mm_
O Cn
n r
Zn
mmil
awl
S.
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Z
0
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