20050985 (2).pdfI / DATE RECEIVED
(/1�(/'� t U iC9�4 C6gj4t /2) �1 ' PERMIT EXPIRES
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ERMIT
CITY OF EDMONDS NUMBERQ�.o
CONSTRUCTION PERMIT APPLICATION JOBSUITE/APT#
ADDRESS
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�OWNER NAME/NAME OF BUSINESS !Vl
no `r PLAT NAME/SUBDIVISION NO. LOT NO. LID NO
WTAILING ADDRESS L Q I' I LID FEE S
O420 6 /1�M�",1/� I�S�PUBLIC RIGHTOF WAY PER OFFICIAL STREET MAp iESCPApprdv' dO VVV rrr ��, ♦ YYY � V VVV Rw Pnrm,l Re wre„f ❑
CITY ZIP —�-- StrolUse Permit Required
EXISTING PROPOSED— Inspection Required HiQ[
1,ONNNlO4 9 36 475 610 33 -- - Sidewalk Required
REQUIRED DEDICATION •�• FT Underground ❑
Mn re uued ❑
NAME METER SIZE LINE SI7 NO. OF FIXTURES PRV REQUIRED
U ' YES 0 NO
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ADDRESS REMARKS w
UOWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP TELEPHONE Z `,9kho I s �- i
NAME CBL#
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ENGINEERING REVIEWED B1Yj DATE
ADDRESS
ORROAD FIRE REVIEWED BY DATE wO
x TY ZIP T _L PHONE '_I
0 O23 o LL m
STATE LICENSE NUMBER EXPIRATION DATE C CKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED EXERT T _
c." (,/I nlJ 'r � c O YES �0
j PROP RTY TAX ACCOUNT PARCEL NO. J CA# ZONE SIGN AREA NEIGH f (n 3:
WWAIVERII ALLOWED PROPOSED ALLOWED PROPOSED - Q M
W 1 �lJ rj^ el/ / '�// STUDY O z'- I �L t� 7, �jr-I 0 C
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❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) O PROPOSED SETBACKS (FT.) mq O
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR C
❑ COMMERCIAL COMPLIANCE OR i
❑ ADDITION ❑ 1:1MIXED USE CHANGE OF USE z 4 m
PARKING LOTAREA PLANNING REVIEWED BY DATE S ITl Z
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED IL -�
F N •-�— L�Vl CJ C�lL G C7 L Q� " C Z .
❑ REPAIR ❑ GRADING CYDS
(40C X T.) REMARKS .�
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING FIRE
Z ❑ CARPORT ❑ ROCKERY WALL ❑ FIRE ALARM LER 71
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a (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: _
STTY E CONSTRUCTION COIX
GROUPmAN
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CNUMBER NUMBER OF / C
OF DWELLING /� %� SPECIAL INSPECTION CONSULTANT OCCUPANT O r•
p STORIES 1i UNITS rJ • ! LOAD O m
REQUIRED 13YES
DESQRIBE WORK TO BE DON C � j
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GEOTECH REPORT �
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P. J Ej Fok STRUCTURAL DESIGN
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ISO F PSI oM �A T>D VALUATION Z
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NODE 1 SOU T (* 6 - Al Description FEE Description FEE ZO
DIDM4 tm N16 7W �� �% "'v <<41 f Plan Check Stale Surcharge
/ Eq' SOURCE LOT SLOPE% VESTED DATE n
Building Permit _ City Surcharge rn
PLAN CHECK O: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
C BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.'
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
i
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Lu 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 # ?��`
= 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 #
1 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, 1 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 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 COMPENSATION INSURANCE AND RCW 18:27.
OFFICALS SIGNAT+IRE DATE
SIGNAT RE (OWNE GENT): DATE SIGNS �j (425) / x
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10 o ` 771 -0220 REL D BY ATE
ATTENTI EXT. 1333
IT IS UNLAWFLTL TO USE OR C UP
Y A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 / IRC110 •' ORIGINAL -FILE YELLOW
h�l.1�6%a��d•� PINK -OWNER •GOLD-- -INSPECTOR
ASSESSOR
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