20051045.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILINGADDRESS
q 40
CITY ZIP TELEPHONE
i,�NS7 71- --?,-7,*
NAME
ADDRESS
PERMIT EXPIRES 't� AV
PERMIT
NUMBER
JOB
ADDRESS,�
UITE/Af�#
/D
Gvl�
(I-]-
PLAT NAMEISUBDIVISION
NO.
T NO,
r
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
rESCP Approved
RW Permit Required
E3
13
EXIST114G
PROPOSED
Street Use Permit Requited
inspection Required
13
Cl
-D
Sidewalk Requited
U n a erg r oun d
13
[3
REQUIRED DEDICATION
FT
. . . . I
C3
E`
METER WE
l'LINt SIZE'
Nd,?llN960U0F
)EBF(WEQUIRED
S,
111isri,
41 ll;T IRR C'
YES13 NOO
n AT
z
lz
1,
-API?
Lu
REMARKS
PROPERT
W
z
OWNER/CONTRACTOR
RESPASWIIAR EROSION CONTROL/DRAINAGE
WATER NIETER TO -BE REMOVED Olt
NAME I GULP
1p A11110—rztit lull
ENGINEE G all 119L.1119"
W, MM'ST ON BACK OF JOB C-PAATRD
tz ADDRESS r
R - I FOR INSPECTION RFQUIREMLUIL�
U
`7 J 21 LA.,dff
,& ..01 FIRE REVIEWED BY DATE Lu
ZIPU TELEP
z CIT't/ HONE
- U -7
0 U(rj
VARIANCE OR CU SHORELINE OR ADBO INSPEC�ION SEPA
STATIf LICE SE NuMidEkR__ _C I 6EXPI ATjO,N ATE,, ECI$E By REOD COMPLETED I EXEMPT
()(0 / 1 1 E3 YES 13 NO
KK r,
CAH ZONE SIGN AREA HEIGH
PROPERTY TAX ACCO
T. PAJ�C EL %0 )SID ALLOWE PROPOSED
WAIVEQt ALLOWED I PROP(
STUDY 13
W 0 )Y
U-!�) 000
14EW RESIDENTIAL. PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
A ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMMERCIAL COMPLIANCE OR
ADDITION MIXED USE CHANGE OF USE z
PARKING LOTAREA DATE
REMODEL MULTIFAMILY SIGN REQ'D I PROVIDED PLANNING REVIEWED BY
13 REPAIR E] GRADING FENCE
CYDS ( X FT.) REMARKS
El OTHER
.F?KDEMOLISH TANK
z EIGARAGE RETAINING WALL Ei FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINE T VIT7Y) E PLAIN.
TYPEk STRUCTION OCCUPANT
27 7�. rEj GROUP
L) VL-z
tu NUMBER NUMBER OF N
cc' OF DWELLING SPECIAL IN0EC'TIbN' CONSULTANT C;CCUPANT
a I UNITS LOAD
0 STORIES REQUIRED 13YES
DESCRIBE WOqK To BE DONE
REMARKS
cc: z
GE6TECH REPORT
BY:
STRUCTURAL DESIGN
bT:
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEATSOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
T_
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
cc PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
LU
PERMIT LIMIT* SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
in
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 #
0: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
4
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 CE LandscapeInsp. Total Amt. Due
_1 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPI.ICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building Official or hisihor Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ,-�ecelpt is acknowledged in space provided.
WORKM�N'S CO OFF(C 1/�CS SIGNATPRE DATE
%RNSATION INSURANCE AND RCW 18:27.
MIA&LEO�VNE ORAGENT DATE SIGNED (425)
V /1� 771-0220 -mELEAsMy D�TE/
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
I
z
0
1
0
M
--I -n
M
C
M C)
0
110
0 C:
M
M Z
z
in
o -n
n
M M
0
0
0 M
C (n
9 C/)
M 0
Z r-
W
z
0
1
0
M
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION -DATE
0
PLEASE SION
PLANNING DIVISION DATE
P -ASES(GN
LC
PROJECT
CO
SITE ADDRESS_ gvc.
0
OC
PERM H Zaa,:T— Z DATE INSPECTED /Z �Z
IT a —ADBY.—,
M
M
Z
DESCRIPTION OF wow'.TO BE INSPECTED 6��4t
Cn
A field inspection was conducted to determine compliance with. *.approved plans. Final approval
0 _n
denotes that there are no ob ectiong from the ove signed Department to the release of
-ab
PERFORMANCE BONDS and the granting of
M M
055
0
G RANT FINAL PROJECT APPROVAL..
C co
9 Cn
M 0
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDI'TIONS given to owner/contrac tor by inspector.
Cn
0
F -AILED FINAL INSI')I.Ic,r[ON - OUTSTANDING ISSU ES
El Copy of CORRECTION N(YFICE given to owner/contractor by inpcctor
2.
3.
R.17-INSPECTE-1) OUTSTANDING ISSUE-S - GRANTFINAL PROJECTAPPROVAL
D ate Sigwiture
,