20051035.pdfDATE RECEIVED PERMIT EXPIRES
kRMIT
CITY OF EDMONDS NUMBER 1W 5-— W 3,�T
CONSTRUCTION PERMIT APPLICATION JOB SUITEiAPTP
ADDRESS 1. 1
i" 7Y4_111)
OWNEFINAME/NAME OF BUSINESS el -_ _51—
ZAAe paiiiii- i v, E (O'B A PLAT NAME]SUBDIVISION NO. LOT NO. LID NO.
cr MAILING ADDRESS
Lu
I LID FEE S
2 qLj_1L_ .57- PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP %717APPIO,la
0 R%V Fleirn.1 Flecio.tvci E3
CITY ZIP TELEPHONE EXISTING Sireet use Permr Reqjifei E3
PROPOSED Inspeci,on Peq�,,rncj 0
slcieAal� Requ'red. 0
undergrouna 13
t> 180 Z4(o No t-4 6 REQUIRED DEDICATION FT W.r.nQ reqj.roa 13
NAME METER SIZE NO.5XTURES PRV REQUIRED
eR lot C cy%-e 1> Ill I L-A YES (3 NOM
I= ADDRESS REMARKS
1A 'I ir OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
cr 7 a0l Lot)
uj
W
ELEPHONE z
CITY ZIP —71
LU
NAME CBL# ENGINEERING REVIEWED BY DATE
?AAA(.Qt4 _�)4!46NLrel,)ILD INIR-0191"7Z 2-
m ADDRESS RECYCLE REVIEWED BY DATE
U
4
CC
CITY ZIP TELEPHONE. PUBLIC WORKS REVIEWED BY DATE
. I '?
1-1 Iiii-fo le F, 230 -2 81 zo(L
STATE LICENSE NUMBER EXPIRATION DATE BY FIRE REVIEWED BY DATE
S
1j *7,5� �f Li
FAIZAco 1> -'k% vim
-J PROPERTY TAX ACCOUNT PARCEL NO. VARIANCE OR CU SHORELINE OR ADS# INSPECTION SEPA
4 REO'D COMPLETED , EXEMPT
Lu 13 YES 13 No
C057 WOO 0003040
CA# ZONE SIGN AREA HEIGHT
WAIVER ALLOWED PROPOSED ALLOWED , PROPOSED
[3 STUDY
NEW RESIDENTIAL PLUMBING I MECH. 13
ADDITION COMMERCIAL COMPLIANCE OR
E] MIXED USE CHANGE OF USE LOT C 'E REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
0
OVERAr
REMODEL ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
MULTIFAMILY SIGN z
C)
GRADING FENCE z
REPAIR El CYDS M ( — X FT.) PARKING IDED LOT ARiTNNING REVIEWED BY DATE 45
DEMOLISH 11 TANK o OTHER R EO'D i PROV 0.
GARAGE RETAINING WALL FIRE SPRINKLER REMARKS
z CARPORT ROCKERY FIREALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
Fur PAEL4 '000R-S FLOOR,
W NUMBER NUMBER OF
rl OF DWELLING
M TYPE OF �JGCTION CODY,, OCCUPANT
0 STORIES UNITS bri da GROUP
DESCRIBE WORK TO BE DONE
SPECIAL INSPECTION CONSULTANT OCCUPANT
12 A_Tl+ qq 46,r REQUIRED 13YES . LOAD
REMARKS
z
ro P4�ei!:S. r
GEOTECH REPORT
4A"Loo 4n e) BY'
STRUCTURAL DESIGN
BY'
LU N
_)o
$
Descripflon FEE Description FEE
HE T SOURCE LOT SLOPE90 VESTED DATE Plan Check State Surcharge
to 16Y tl.,
14- 1 IC. Building Permit City Surcharge
PLAN CHECK NO: V-0
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEESj ETC.) WILL REQUIRE
j SEPARATE PERMISSION. Grading
M PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Lu Engr. Review Recording Fee
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk, Depositi
in APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
_j
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
M
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT.- ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Landscapelnsp. Receipt #
=1 I — I
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 CALL This application is not a permit until.sign0d by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION Building Official or his/her Deputy, and Feesafe paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknowledged in space provided
WORKMEN'S COMPENSAT�� RANCE AND RCW 18:27. (425) 6C I ICIALS SIGNA RE 10 TE
SIGNATURE (OVAER OR kt D 7TE SIGNED Ro
-7 - C) "S 771.022 1 66SED qY
it EXT. 1333 ot
A 01rCK11r1nK1 Wk
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL _,Nz7_71_ I t
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - 114SPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
6105 PRESS HARD - YOU ARE MAKING 4 COPIES
I T
z
0
1
0
M
q 9
0 M
C
MID
0
—40
0 C:
M
M Z
z
—4
0 -n
n
--i
x
M M
0 Vi
0 r-
0 M
C cl)
90
M 0
z
X
z
Cn
z
0
i
0
M