20051023 (2).pdfDATE RECEIVED
PERMIT EXPIRES J` --O
CITY OF EDMONDS
PERMIT
vVsbY UZ�
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS 7
OWNER NAME/NAME OF BUSINESS
Lcn ) PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS C /l/ CJ LID FEE S
N/ FT— a PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Req d ❑
l7 1 ���'�"��� RW Permit Required ❑
CITYStreet Use Permit Requited 13ZIP TELEPHONE EXISTING PROPOSED inspection Required ❑
mrW OUndergrauu^ �yy.rmnU�REQUIRED DEDCATION
ro uvod ❑
NAME METER SIZE LINE SIZE NO.tOF F,IxTURES:1 ' 4 �;ISYRV REOUIREO
Sy .
t" � ,y.�ut ,i ,f j +:4• „/,..,
YES El NOO Z
{ \ s{
ADDRESS REMARKS q q fit..} c sstt44 yy* * (t +:? ;st"`.:..+•• ' °•' w
OWNER/CONTRACTORRESPONSIBLE�OR,&ROSIONCO,NTROL/DRAINAGE
w
CITY ZIP TELEPHONE
CBL#
NAME t ^ ]� V L x
.r�..`L}i<' .� {}�`
vF'MTV ,Pbw1"61 A1&- 4�/ ! 1 V ENGINEERINVIRBY(EW Otf§'f ••. ' )if;.DATE
ADDRESS
�i i1xl��Qi1 l+(� 5)i}A(± �»•.. ---�
t>°au....-....,,..:.».,.
CITY ZIP TELEPHONE FIRE REVIEWED BY DATE WW
iz
LYA)A) WOOPy
STATE LICENSE NUMBER EXPIRATION DATE C ECK Y ARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
OYES ONO
I
PROPERTY
TAX CAN ZONE SIGN AREA HEIGHT
�X jACCOUN7 PARCEL NO. WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED j
V —7 7 OO OI /�✓ STUDY O
❑ NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
IIIJIIX ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR ?
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE z
❑ REMODEL El MULTIFAMILY ❑ SIGN REQ'DARPIROVIDED LOTAREA PLANNING REVIEWED BY DATE g
❑❑ GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
❑ DEMOLISH ❑ TANK ❑ OTHER
❑ GARAGE RETAINING CARPORT El ROCKERY WALL ❑ FIRE ALARM FIRE LER
(TYPE OF USE, BUSINESSORACT�iY) E PLAIN:
IT TECO CONS DIN C %; OCCUPA;LOAD
GROUP
NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS I
I REQUIRED L YES
DESCRIBE WORK TO BE DONE
f REMARKS
~•� I A r 1 /���"' 0e1j �AI GEOTECH REPO T
I STRUCTURAL DESPN
_) /�, ) BY:
f �1fil �1D m! /C-[��A VALUATION
Description
Plan Check
HEAT rS0 RCE LOT SLOPE% VESTED DATE
%V Building Permit
PLAN CHECK NO: Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
i DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading
i SEPARATE PERMISSION, Er1gG RBVIBW
It W PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONOS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ot ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
T 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.
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION
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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAGO&SdDOE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPEN9A CE AND RCW 16:27.
SIGNAT OWNER R AG NT DATE SIGNED (425)
771-0220
FEE Description
State Surcharge
�l City Surcharge
V \ Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
,
Receipt #
APPLICATION APPROVAL
This application is not a ponnit until signed by the
Building Olficial or hislhor Deputy* and Foes are paid, and
rucoiflits acknowle Iged in space provided.
FICIAL
x
URE uDATE�
I -
.C. +EU iY DATE
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, UBC109I IBC110If IRC110,
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL . FILE YELLOW • INSPECIOR
PINK • OWNER GOLD • ASSESSOR
0
z
O
m
O
n
M
l I9
0)x
O
M
MO
=M1O
OC
mZ
K) —1
C Z
r —I
m mn
MMI
mrn_
ON
r
M
t m0
Zr
X
D
0),
Z
O
MA
n
m
I