20051048.pdfDATE RECEIVED
/ PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER f.
CONSTRUCTION PERMIT APPLICATION SUITE/AP7#
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ADDRESS / j 4e / J
OWNER NAMEINAME OF BUSINESS
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M"Oon et I d 11 V/ Sj+ tjtj G PLAT NAME/SUBDIVISION NO. LOT NO LID N
W MAILING ADDRESS
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3 10 2 G Q tic P00 fi � ��� (/�. � � 3 �� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0
O RW Permit Required 0
CITY ZIP TELEPHONE EXISTING PROPOSED Street Use Permit Requited 0
Inspection Required
0 (� n A Sidewalk Required
��� V v�' / REQUIRED DEDICATION FT Underground 0
'Wiring required
0
NAM�iE^ �• u - / METER LI NO. OF FIXTURES PRV REQUIRED
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NAME CBL#
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
Sp�. CT�. co�� /tL 7/01/0r. ` REQ'D COMPLETED EXEMPT
1 /'r Act, � O YES NO
PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
W WAIVER E3 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY O 0000
❑ NEW ❑ RESIDENTIAL EL ?LUMBING ! MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED ^FRONT SIDE REAR FRONT UR�SI`DE REAR
❑ ADDITION �CbMMERCIAL. ❑ CHANGE OF USE {� I V/ ISI N O Cti N � z
❑ MIXED USE
® REMODEL❑ ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE 5 MULTIFAMILY SIGN REQ'D PROVIDEDD1 d
❑ REPAIR ❑ GRADING ❑ FENCE N AN Li G '� ` �' 0 4 1 �
CYDS ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE FIRE
CARPORT ❑ R CKIERY NING WALL ❑ FIREALARM SPRINKLER
a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
H t�r?'�.STrN% AR /�s (�/A TYPE OF CONSTRUCTION CODE GROC
OUP NT
W NUMBER o1/I NUMBER OF �" �_(jD
OFDWELLING
O STORIES �Ao3;# � &Aorr UNITS SPECIAL INSPECTION CONSULTANT OCCUPANT
n LOAD
DESCRIBE WORK TO BE DONE A— I, REQUIRED 1:1 YES
416W Ilf *'i0'r ,V REMARKS
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GEOTECH REPORT m
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BY:
VALUATION``
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Description FEE PDescription FEE
Plan Check 1. —rcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit harge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
W 1.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
n PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION g p.
rn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE; HEIRS, ASSIGNS AND SUCCESSORS Fire Review - Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fife InS ection -�
_ ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY p Receipt #
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. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
ON Recording Fee Receipt #
GIVEN IS CORRECT; AND ETHAT TI AM THE OWNER, ORI HAVE READ THIS THE DULY �AUTHOR ZED AGENT THAT THE IOF APPLICATION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or hisrhor Deputy: and Fees are paid, and
IN VIOLATION OF THE LAB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATI 9fI URANCE AND RCW 16:27,
Off I AL3SfOPOATURE ATE ,
4SIGNgATUOR NT)' DATE SIGNED (42S) 771'0220 RELE SED BY AT
EXT. 1333 (UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I `tLj
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110. ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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