20051057.pdfDATE RECEIVED I i _ �" •.
t PERMIT EXPIRES —�!L
PERMIT ��
CITY OF EDMONDS NUMBER o� I:)
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS \Y �,tQ SUITE T
I��VI- �YL
O R NAME/NAME OF BUSINESS
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a PLAT NAh16'SUBDtVIS10N NO. LOT NO. LID NO.
¢ MAILING{�DDRESS LID FEE S
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•�. � /� �1 �� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appro�ea ❑
� , RW Permit fieq(aee„+++ H1Y Permd fiegd,rea ❑
TELEPHONE EXISTING _ street Use Perm(Regwren ❑
CITY ZIP
7 - _ .--.PROPOSED _._.----_- - .-_--_-_ __ inspection Roq.mea ❑
REQUIRED DEDICATION FT . underyrauna
Wiring iertkiana ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YESE3 N013
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t ADDRESS REMARKS U� i
V OWNER/CONTRACTOR RESPOAflS�JT�t�/DR ¢
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CITY ZIP TELEPHONE 5
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NAME CBL# ENGINEERING HEVIEWLU UY - - • '•+��
¢ ADDRESS RECYCLE REVIEWED BY DATE
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¢ ZIP T LEPHONE PUBLIC WORKS REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE EC B FIRE REVIEWED BY DATE w¢
LLL \ 9900 - C3 LL
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
,PROPERTY TAX ACCOUNT PARCEL /�Q] REO'D COMPLEIED EIIEILPT
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W �O c v ��� �C2� OYES 0 NO
J CA# ZONE SIGN AREA HEIGHT
❑ NEW RESIDENTIAL LIMBI MECH ❑WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
❑ COMMERCIAL YYY"` COMPLIANCE OR E3 STUDY
❑ADDITION
❑ ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS AR
MIXED USE ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
❑ REMODEL ❑.. MULTIFAMILY ❑ SIGN z
z
GRADING FENCE z
❑ REPAIR ❑ CYDS ❑( X FT.) PARKING LOT AREA PLANNING REVIEWED BY DATE a
OTHER REO'D PROVIDED
❑ DEMOLISH ❑ TANK ❑ I
GARAGE RETAINING WALL FIRE SPRINKLER REMARKS
z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
CIL (TYPE OF USE, BUSINESS OR ACTIVITY) EXP! IN:
ar
w NUMBER NUMBER OF
OF DWELLING
O STORIES UNITS rREMARKS
T N OCCUPANT
GROUP ��
DESCRIBE WORK TO BE DONE
CTION CONSULTANT OCCUPANT
- � l YES LOAD
ORTESIGN
VALUATION
$
Description FEE Description FEE
HEAT SOURCE LOT SLOPE06 VESTED DATE Plan Check Stale Surcharge
Building Permit City Surcharge' 1 -
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 PUBLIC
2. DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
It SEPARATE PERMISSION, Grading
wPERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review Recording FOB
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr, IRSpeC110n Plan Chk. Deposit
y *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review R8C@IPl ty
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection Total Amt. Due �
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE p
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Ir1Sp. RBCBIPt if i
N.•
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIO
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 1 CALL This appticetion is not a permit until signed by the
THE OWNER.I AGREE TO C MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• Building Official or his/ er Deputy: and Fees are paid. and
TION; AND IN DOING THE RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt i5 ack edged in ace provided
IN VIOLATION OF THE LAPORMIDE OF THE STATE OF WASHINGTON RELATING TO
WORKr EN'S COMPEN ANCE AND RCW 18:27. (425) ;RELEASED
ICI I N UR DATE,
I'N L(OWNE R GENT) 71,ESIGNED ���-LOJnnO. // •,y J3J BY `DATE
EXT. 1
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC1100 PINK -OWNER GOLD ASSESSOR
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