20051003.pdfDATE RECEIVED1,17
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L;711(�'> >PERMIT EXPIRES `
PERMIT
CITY OF EDMONDS NUMBER c�{ ���
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS �V � / SUITEIAPT#
OWNER NAME/NAME OF BUSINESS f 1 3 �L���%� 1 r!��J /yGJ4/L
ple 0)op� Cil /gyp / M Z:L ta-NI C �v 1 j PLAT NAMEISUB DIVISION NO. LOT N0. LID NO.
w �MAILING ADDRESS LID FEE 5
L. 3 y O 3Peoiliv ncvb pg% ve PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
O RW Permit Required 0
CITY ZIP TELEPHONE EXISTING PROPOSED Street use Permit Required O
�p„lfotj � Cl g0U V& •. SY� Inspection Required O
..- JU Sidewalk Required E3
L•• V Unilxrground 0
REQUIRED DEDICATION FT
— —
Wiring required O
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
u YES 13 NO 0 =
W 1
ADDRESS REMARKS w
UOWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
w
CITY ZIP ITELEPHONE
EN INEERING REVIEWED BY DATE
IX ADDRESS
FIRE REVIEWED BY DATE
a CITY ZIP TELEPHONE tr
u 5L 77ZG q r g z y- ��-3o /Z�3 LL
STATE LICENSE NUMBER EXPIRATION DATE ED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED EXEMPT
V 13 YES ON
O
PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
w 6007 71300 /�-q /� �-7 0- WAIVERC3 ALLOWED PROPOSED ALLOWED PROPOSED
Yv V STUDY C3 -
❑ NEW ® RESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE Z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED a
C]❑GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS (
❑ DEMOLISH ❑ TANK ® CIA — IZv49F
_ ❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIRE ALARM
a (TYPE OF USE, BUSINESS OR ACTIVITY) E IN:
TYWJ=
OCCUPANT ��V GROUP
W NUMBER NUMBER OF
OF 2 DWELLING / SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
REQUIRED 1 YES
DESCRIBE WORK TO BE DONE �/
i%U L1�i�„�. E�F�i���G�� ��jp�,rl�j��, REMARKS z
to 77V9 0�L+ I A`Jif tl / /VA Lx-''r'P) tlND GEOTECH REPORT
rr�Ti� CA�• �►/ / �i �a� /a/rx'p �'�� STRUCTURAL.DESIGN ,
BY:
VALUATION
�EFt�S� f /V'tw r "..zp or�iH� - Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% - VESTED DATE �1
Building Permit 5V v City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION,
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
in
Uj
j 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 IDSA. TOtaLAml. DUeL�
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY. ORDINANCE PROVISION'*
Recording Fee Receipt # 23.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION I �J L APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF I �'
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC•Qb'�y('�(} �'�i6 t This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED "��' I I gIV Building Official 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 C NSATION INSURANCE AND RCW 18:27.
OFFICIALS 9tGNATURE DATE
SIGNATURIE WNER R AGENT): DATE S NED ^`
27
�o-
k}�(425)
771-0220 RELIfASED BY D E
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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I PINK IRC110. ORIGINAL •FILE YELLOW -INSPECTOR
PINK -OWNER •GOLD -ASSESSOR
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