20051022.pdfDATE RECEIVED
[PERMIT EXPIRES
elm
ERMIT
CITY 01� EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
0 A
: OWNER NAME/NAAAF OF RUSINESS,
1�_
f__ rz/ PLAT NAMEiSU B DIVISION NO, LOT NO LID NO�
_r-71 � �Ic .
MAILINGADOReSS LID FEE S
Tty� 6rZ461/tl - I
PUBLIC RIGHT O�AAY 66A OFFICIAL STREET MAP TESCPApprowed 13
O_,61 Rw Permit Required E3
Street use Permit Required 13
CITY— Zil TELEPHONE EXISTING PROPOSED Inspection Required [3
SidaAalk Required 0
REQUIRED DEDICATION FT underground [3
. ........ W"Wre 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YESO NOO z
U FE
Lu Lu
I= ADDRESS REMARKS W
x OWNERICONTRACTOR RESPONS113LE FOR EROSION CONTROUDRAINAGE z
U
z
W
CITY ZIP TELEPHONE
NAME CBLN
ENGINEERING REVIEWED BY DATE
ADDRESS
jq3jo qto* &-w— FIRE REVIEWED BY DATE LU
z cl ZIP
I TELEPHONE
U
A, 'S -7 7+ r"to 4,
rp I VARIANCE OR CU SHORELINE OR ADBill INSPECTION SEPA
STATE LICENSE NUMBER ITE CHF4KED BY
REQ'D COMPLETED I EXEMPT
E3 YES E3 NOI
_j PRO?EqTY TAX ACCOUNT PARCEL RO. CA4 ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED , PROPOSED ALLOWED , PROPOSED
W z_/0#e;P 4
7 '2 4�1 1,
_j - STUDY C3
NEW RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT.)
13 PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/IRSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR z
1:1 CHANGE OF USE
MIXED USE
REMODEL O�SL�Olw PARKING LOT ARETLANNING REVIEWED BY DATE
�$�MULTIFAMILY 1:1 SIGN REQ'D I PROVIDED
GRADING FENCE
REPAIR CYOS 1:1 x FT.) REMARKS
OTHER
DEMOLISH TANK
z 0 GARAGE RETAINING WALL �gFIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: f
TYPP )E OCCUPANT
�®rC INSTRUCTION GROUP
U 4&".04 1 , 4— 0
U) �j j1,4
Lu NUMBER NUMBER
0 OF DWELLINU9F SPECIAL INSPECTION CONSULTANT OCCUPA
M RIES 94- A6j4'<z UNITS LOAD
o STO REQUIRED DYES y
DESCRIBE WORK TO BE DONE
REMARKS
z
V0 I ljk& E: 4::' 1 Iz C, P
GEOTECH REPORT
BY: Ila
Lk I P t4 a- N I—, STRUCTURAL DESIGN
BY:
VALUATION
0/� Description FEE
Description FEE
HEATSOURCE LOT SLOP�7__� VESTED DATE Plan Check State Surcharge
Building* Permit City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
t:
N _7 Engr. Review
PERMIT APPLICATION: SEE ECDC 1 9.00.005(A)(5)
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
U)
L" 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 #
x 1A
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 Landscapelnsp. Total Amt. Due
CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
0 NOR LIMIT IN ANY WAY THE
M. #
Recording Fee Receipt V
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAI
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
LY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a pernit until signed by the
THE OWNER. I AGREE TO COMP CALL Building Official or hisiher Deputy: and Fees are paid. and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
I SIG URE DATE
SIGNATU WNER 0 GE DATE SIGNED (425) 0 1c,
771-0220 RWSED BY D
ATTENVOW EXT. 1333
P,////)
U BUILDING OR STRUCTURE UNTIL g-
IT IS UNLAWFUL TO USE OR OCC PY I-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE - YELLOW - INSPE40R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC1110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU.ARE MAKING 4 COPIES
z
0
A
0
M
11 -n
CA
0 M
a 0
M 0
-40
0 C:
M
M z
0-1
C -
> z
F- -i
0 -n
n
M M
0
0
0 M
C CD
M 0
Z
X
z
CD
z
0
1
0
M