20051019.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CI ZIP TELEPHONE
NAME
TELEPHONE
FPERMIT EXPIRES
PERMI
NUMBER CQ00Si_
JOB
ADDRESS
4,�,/�721
PLAT NAMEISUBDIVISION NO LOT, NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING —_ PROPOSED
REQUIRED DEDICATION FT
METER SIZE
REMARKS
OWNER/CONTRACTORRlAp7c�i'PW',4,Rf&Sf'P NW'haol
SUITE/APTP
LID NO
LID FEE S
TESCPApproved
RW Permit Required
13
Street Use Pernisi Required
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inspociiian Required
13
Sidewalk Required
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Unclurg(ciund
E3
�ifinq required
13
j?)1V REQUIRED
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N VME C C70 �/C/ / DATE
ENGINEERING REVIEWED BY
ADDRESS
C_/6 0
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ZIP TELEPHONE LL
or & Industries
--- VARIANCE OPU7 IN 1$ePA
-ADB#TE31 YES 13 NO MPLIT6D I E)1E1IPT
t"OREL
STATE LICENSE NUMBER EXPIRATION DATE CH REOD CO
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9166 CA# ZONE SIGN AREA E3 Nor HEIGHT
I-JI PROPERTY TA)�ACCOUNT PARCEL NO. I ALLOWED PROPOSED ALLOWED PROPOSED
WAIVER El I
STUDY 13
RESIDENTIAL
�UMBIN
LOT COVERAGE
REQUIRED SETBACKS (FT.)
REAR
PROPOSED SETBACKS (FT.),
FRONT L/RSIDE REAR
NEW
ALLOWED PROPOSED
FRONT SIDE
I
ADDITION
COMMERCIAL
COMPLIANCE OR
I
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USE
CHANGE OF USE
ri MIXED
PARKING
LOTAREA
PLANNING REVIEWED BY DATE
REMODEL 1:1 MULTIFAMILY Lj SIGN REO'D PROVIDED
FENCE
REPAIR 0 GRADING CYDS 1:1 ( x FT.) REMARKS
OTHER
DEMOLISH 11 TANK 1:1
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY 13 FIREALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAft
TYP Coq T C F OCCUPANT
I GROUP
NUMBER NUMBER OF IS
L OCCUPANT
OF TDWELLING SPECIAL INSPEET16N CONSULTANT LOAD
U6
STORIES UNITS f"ll
REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
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Description
_44
Plan Check
1IEATSOURCE
LOTSLOPE%
VESTED DATE
Building Permit
—PLA9
CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
:E
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
Engr. Review
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 119.00.005(A)(5)
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PERMIT LIMIT.SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF 0 . F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
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IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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EDM DS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF A NY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
0 �^DDCCT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
FEE Description
State Surcharge
City Surcharge
Base Fee
ulv=" I i - CALL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. 140 PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABQH CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSOInRNK NCE AND RCW 18:27.
SIPNAT$0 (OWNER 0 AGE T):' PATE SIGNED (425)
771-0220
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FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
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1 Receipt # i5q
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
DAT
FICIALS SIGN] jj�ZE 65
DATE
AfTtNTION 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 IRC110.
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ORIGINAL - FILE YELLOW SPECTOR
PINK -OWNER GOLD - ASSESSOR
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HEATING:
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Equipment .................
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EXTERIOR SHEATHING
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FRAMING ........................
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INSULATION * ...................
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Wall Insulation ...........
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Ceiling Insulation .......
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL_FqW
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