20051047.pdfDATE RECEIVED
PERMIT EXPIRES
6ERMIT
CITY OF EDMONDS NUMBER f/ 77
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS,,
OWNER NAMEINAME OF BUSINESS �2
PLAT NAME/SUBDIVISION NO. T NO. LID NO.
_Vt A f1f\ n LO
MAILING
uj ADDAES LID FEE S
z
?: 0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TLSCI' ApPrOV00 [3
0 16 �)_ RW ['01M.1 ReCii,f0d E3
CITY ZIP TELEPHONE EXISTING siteal use pe,mr Aeqj,red [3
PROPOSED inspect�on Required 13
Soeha!K Fleriu,fed 13
;�35 LjSbj REQUIRED DEDICATION FT Undo(ground C1
W,r,nrj foriu,100 13
NAME METER SIZE NE SIZE NO. OF FIXTURES PRV REQUIRED
U T YESO NOO
uj
I= ADDRESS REMARKS
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
x
Lu
W
TELEPHONE z
z
W
C L# ENGINEERING �EV.ICWED BY TMA
�i 4,11 El) L. Ell
4 A -.4 b,&
RECYCLE DATE
ce ADDRESS V REVIEWED
j�o e _Z
A
Y ZIP TELEPHONE PUBLIC WORKS REVIEWED BY DATE
0
STATE ICE E NI Il`jBER EXPIRATIO DATE EC E Y FIRE REVIEWED BY DATE uj
cc
G 0 0.1
- IV' VARIANCE OR CU SH7RELINE OR ADB# INSPECTION SEPA
PROPERTY TAX ACCOUNT PARCEL NO,
REO'D COMPLETED EXEt,?,PT
W 13YES 13NOI
D 5 LA (D 'a L) o 1) 11 r I I I
CA# ZONE SIGN AREA HEIGHT
;;A
NEW M��ESIDENTIAIL PLUMBING I MECH D ZAIVER ALLOWED I PROPOSED ALLOWED , PROPOSED
CC 3TUDY
COMMERCIAL !mnOMPLIANCE OR [3 STUDY
......... .
ADDITION MIXED USE CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS( 7) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REA FRONT L/RSIDE REAR
REMODEL a
MULTIFAMILY SIGN, z
GRADING FENCE
REPAIR CYDS X FT.) PARKING LOTAR REVIEWED BY , DATE <j
IDED
1:1 DEMOLISH El TANK OTHER REO'D I PR OV
cGARAGE RETAINING WALL FIRE SPRINKLER REMARKS
CARPORT ROCKERY FIREALARM
(TYPE OF USE. B ES 0 ACTIVITY) EX I N::
M
U
w NUMBER N='ClFrE�r,
OF DWELLING
STORIES UNITS TYPE rO=. I CODE OCCUPANT
GROUP
DESCRIBE WORK TO BE DONE
SPECIAL INSPECTION CONSULTANT OCCUPANT
LOAD
REQUIRED 13YES
1 A 40, A
REMARKS
z
51 GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY,
VALUATION
$
Description FEE Description FEE
HEAT SOURCE LOT SLOPE96 VESTED DATE Plan Check State Surcharge
PLAN CHECK NO: Building Permit City Surcharge
Plumbing Base Fee C�X/
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
_j SEPARATE PERMISSION. Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W Engr. Review Recording Fee
0. PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit
dAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
in
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt It
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
it Fire inspection Total Amt. Due
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' La dscapelnsp. Receipt H
x - I 1 0
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 signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- Building Official or hisihei Deputy and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO 1�) I
WORKMEN'S COMPENSATIO241TURANCE AND RCW 18:27. (425) O�K 11 1 S SI 4AT R DAT
GNATU E (OWNER OR GE DATE SIGNED
771-0220
RELEASED BY 11)AT
EXT. 1333
AtTENTION
IT Iti UINLAVV I7U6 I w
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FicATE OF OCCUPANCY HAS BEEN GRANTED. UBC1 09 / IBC1 10 / IRC1 10.. PINK -OWNER GOLD ASSESSOR
PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
M
4 -n
M
C
M 0
0
10
0 C
X M
M Z
10 --1
C _z
0 _n
M M
0 _0)
0 f-
0 M
C 0)
M 0
Z
X
>
z
X
0).
z
0
i
0
M