20050982.pdf1 '/q/4 �IO I e, r J��j� /J DATE RECEIVED In ►
CITY OF EDM�ONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
�ic:TO .IA KINL
MAILING ADDRESS
qq
CITY _?jp TELEPHONE
Edr)jrnd,,5 I*
NAME
3
PERMIT EXPIRES
PERMIT''
NUMBERJOB ( !�
ADDRESS i r�� 9 ��UITE/LPTJJ�
PLAT NAMEISUBDIVISION NO. ' LOT NO. LID NO. t4� (`
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved Q
RW Permit Required Q
Street use Permit Required Q
EXISTING _ PROPOSED inspection Required Q
SidewalM Required - Q '
REQUIRED DEDICATION FT underground Q
Wiring required Q
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
iY
w
REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
z
W
ENGINEERING REVIEWED BY DATE
ADDRESS
31c ��LIzcY1411,►���
FIRE RJWIEWED BY DATE w
CITY ZIP TELE ONE �� �' `
STATE LICENSE NUMBER EXPIRATION DATE ECKED Y VARIANCE OR CU SHORELINE OR ADBN INSPECTION SEPA
REQ'D COMPLETED. 1 EXEMPT
YES ONO rn
CAN ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
O/' ,^ L/� WAIVER O - ALLOWED PROPOSED ALLOWED PROPOSED
L �6) STUDY 0 �_
❑ ❑ LOT COVERAGE REQUIRED SETB CKS (FT.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL PLUMBING / MECH N =
ALLOWED PROPOSED FRONT SID REAR FRONT UR SIDE REAR D rn
❑ COMMERCIAL COMPLIANCE OR _ C 0
❑ ADDITION ❑ CHANGE OF USE !!! z O
❑ MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATEg O 0
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED a 06�1 C
FENCE S M
❑ REPAIR ❑ GRADING CYDS ❑ ( X FT.) REMARKS / �Q� s/� Q� m Z
❑ DEMOLISH TANK C► ❑. OTHER C Z
❑GARAGE RETAINING WALL FIRE SPRINKLER i r --1
CARPORT ❑ ROCKERY ❑ FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: iA
OCCUPAN
OF T UCON CODE
T •� 0 -n
6• k o� TYPE GROUP
0
NUMBER NUMBER OF
6t
OF DWELLING f . SPECIAL INSPECTION CONSULTANT OCCUPANT '
STORIES ' UNITS LOAD = M
M
REQUIRED YES rn'
DESCRIBE WORK TO BE DONE ��±± fp� 1 0 (n
5 O (T t- l REMARKS o I n rn
1( r�
GEOTECH REPORT m C c
� ��11 /'
BY: I } rn n I
PAM / Ci Lp•G STRUCTURAL DESIGN i
BY: 74
Fiziolm PARa1K(1:% AiZQ±J3'1 VALUATION
Wei
/ 1 PT al t I $ D
`� z
D n/ i� GV 1 Description FEE Description FEE
I
Plan Check State Surcharge !A
HEAT SOURCE LOT SLOPE% VESTED DATE Z'
Building Permit City Surcharge i O
PLAN CHECK NO:�/ � Plumbing / Base Fee n
rn.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanICBI
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
[ DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
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
014 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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
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 parrnd until signed by the
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 CALL Building reOffceipt
i or acknowledged
Deputy: and Fees 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 COMPENSATION INSURANCE AND RCW 18:27,
OFNZU DATE.
S U kE (OWNER . AGENT): DATE SIGNED r' d75(425)
�0 V 771 =0220 'TELEASl BY DATE
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- ORIGINAL - FILE YELLOW • INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED- UBC109 / IBC1101 IRC110• PINK -OWNER •GOLD - ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
... vrc ..;y.q