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20050991.pdf1�"t%F—DXTE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS �' i W MAILING ADDRESS 10 1 t A L rL 's CITY ZIP TELEPHONE NAME Iw— ADDRESS x Q CITY ZIP TELEPHONE NAME ti L d [PERMIT EXPIRES ZONPERMIT E NU BER�I�,S/�!�1�� f JOB SUITE/APT# ADDRESS. PLAT NAME/SUBDIVISION NO, LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑ RW Permit Required ❑ Street Use Permit Req'd ❑. EXISTING PROPOSED Inspection Required ❑ Sidewalk Requited ❑ REQUIRED DEDICATIOrj�,,.F.T• erground fling required 0 METER SIZELINE SIZE tJOor 'r. OF FIX B V REQUIRED i•� �! yi� tiWi rpt. !. �I NO ❑ REMARKS 11 !; ((ttt�i: ¢ �a 046 ij, " I i OWNER/CONTRACT R ArSfF�I;1SIBL`E M9 �RU, ONTROL/DRAINAGE z LU ACTION WATE9, HEATER ONLY INC (� .TOTEMCOMMERCIAL CENTER1 �"� ENGINEERING REVIEWED/DATE 0 ADDRESS 1271)4 NE 124th ST 9 43 f - y AND � FIRE REVIEWED BY DATE w i CITY ZIP TELEPHONE LL O STATE LICENSE NUMBER EXPIR ION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBq INSPECTION BOND '•� REQ'D POSTED. crio�d'5:5'1 l f7%7 ❑YES ❑IG SEPA REVIEW SIGN AREA HEIGHT a PROOPEERRTTYJ_AAXX[AQC+OUNT PA CEL NO. COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED Uj e / 3 .+ o C �OC J EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ❑ NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR O ❑ ADDITION ❑ COMMERCIAL ���❑'''COMPLIANCE OR ��� CHANGE OF USE z PARKING LOT AREA PLANNING REVIEWED BY DATE a REMODEL ❑ APARTMENT ❑ SIGN REO'D I PROVIDED GRADING FENCE ❑ REPAIR' ❑ CYDS ❑ ( X FT', ❑ DEMOLISH ❑ TANK ❑ OTHER GARAGE z ❑ CARPORT ❑ RETAINICXERNG WALL ❑ RENEWAL P: (TYPE OF USE, BUSINESS O ARTI ITY) EXP •AIN: U U) . NUMBER NUMBER OF CRITICAL OF DWELLING AREAS oSTORIES UNITS NUMBER DESCRIBE WORK TO BE DONE edAS -01 011(16- 7`V 3S',ti<b `Ci�fS' CHECKED BY. T F ONST N CODEOCCUPANT GROUP SPECIAL INSPECTOR A OCCUPANT REQUIRED ❑ YES LOAD REMARKS O PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5 m VALUATION FEE PLAN CHECK FEE 04f HEAT SOURCE. GLAZING % LOT SLOPE % BUILDING PLAN CHECK NO: VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t- BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC GRADINGlFILL DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE M SEPARATE PERMISSION, I j Q E PERMIT APPLICATION: 180 DAYS W PERMIT LIMIT: 1 YEAR • PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION rn "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE rn w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEIPT DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE iNOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.` REC 00TOTAL AMOUNT OUE p � S 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• CALL This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or his/her 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 COMPENSAT10SURANCE AND RCW 10.27. O ALS IG RE DATE SIGNATU E (OWNER 01�� ENT) D7,,/rGNED/ (425) // s i ,l- 771-0220l RELEA D Y ATE A NTION EXT 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL. FILE YELLOW • INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK -OWNER GOLD -ASSESSOR 5198 I n i M cM mO v On _ i