20051059.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAIAE�NAME OF BUSINESS
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MAILING ADDRESS
2-2-clo( F-OkA01VUS WAV
CITY ZIP I TELEPHONE
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ADDRESS
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CITY ZIP TELEPHONE
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NAME
STATE LICENSE NUMBER EXf IRA�TION DATE
PROPERTY TAX ACCOUNT PARCEL NO. t=1('[iA15
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NEW
RESIDENTIAL
E . I ADDITION
COMMER CIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING cybs
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
10
PERM'IT EXPIRES
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PjRMIT
NUMBER
JOB
SUITEIAPT#
AD DRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.-
6&&*"-T -1
64-
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApprovM
RW Permit Required
EXISTING PROPOSED
Street Use Permit Required
Inspection Required
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Sidewilk Required
13
E3
REQUIRED DEDICATION FT
Underground
Winne mquited
13
METER SIZE
LINE SIZE.
NO. OF FIXTURES
PRV REQUIRED
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0 SIDE SEWER MUST BE CAPPED
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HOSE BIB wrni AVB INSTALLED
ENGINEERING REVIEWED BY DATE
0 DUMP AT APPROVED DUMP SITE ONLY
LjIl L I UN 1M-NFbU I I UN
FIRE REVIEWtW4 W
CKLIST ON BACK OF JOB C95
FOR INSPECTION REQUIREMENTS U.
BY VARIANCEORCU SHORELINEORADB# I INSPECTION SEPA
REQ'D 1 COMPLETED I EXEMPT
13 YES 13 N
CA# ZONE SIGN AREA HEIGHT
WAIVER I ALLOWED PROPOSED ALLOWED PROPOSED
XV40-f- 01661 STUDY [3
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY
SIGN REQ'D PROVIDED
FENCE I
( X FT.) REMARKS
OTHER
FIRE SPRINKLER
FIRE ALARM
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In
0
OF
STORIES
_61EsCRIBE
DWELLING
UNITS
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SPECIAL INSPECTION
REQUIRED 13YES
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WORK TO BE DO NE.
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REMARK
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GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
by:
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VALUATION
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Description
4_�x- 40�_ 70Z
Plan Check
HEAT SOURCE
LOTSLOPE%
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OrSfirED DATE
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Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC ig.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
OCCUPANT
GROUP .
CONSUL
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
DATE
FEE
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fife Review
Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
0:
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 NCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA
Lindscapelnsp.
Total Amt. Due
l�j
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
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Recording Fee
Receipt # ,?-71,7 q
1 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
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
Building Official or his/her Deputy: and Fees are paid, and
TION;
IN VIOLATION OF THE LAPLQR CODE OF THE STATE OF WASHINGTON RELATING TO
receipt is acknowledged in spice provided.
FOR INSPECTION
WORKMEN'S COMPENSA)��NVRANCE AND RCW 18:27.
OFFICIALS SIGNATURE DATE
I E �4): DATE SIG' NE
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(425)
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PRE d(ON
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771-0220
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RELEXS'ED BY DATO
ATTENTION
EXT. 1333
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 / IRC110.
PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERM ITCOORDfNATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT. DATE
I ASESIGN
ENGINEERING DIVISION DATE
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'�NA7ASE sibN-
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PLANNING DIVISION DATE
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PLEASE SIGN
PROJECT AAf? 1
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PERMIT# A�DB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED Q mo
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A field inspection w as conducted to determine compliance with approved plans.
'Final approval,.,
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denotes, that there are no objections from the above signed Department to
the -release Of
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECTAPPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to. owner/contractor. by inpector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fornis:ocaprv1 3/25/04