20051061.pdfI
r DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUF31NESS
MAILING ADDRESS
CITY zip
NAME
ADDRESS
NAME
ADDRESS
TELEPHONE
CBL#
[PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APT#
ADORESS.�)
PLAT AMEIS413DIVISIONtO. LOT NO� L
)V
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I ESCP Approved
RW Permit R U' d
EXISTING PROPOSED Street Use P=11'Rriquired 13
Inspection Required
Sirlowalk Required
7 REQUIRED DEDICATION FT Underground
Wirinq requited
METER SIZE LINE SIZE NO, OF FIXT URES PRV REQUIRED
YESO NO 13 0z
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REMARKS lu
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 3
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WAt:;1aTVJk I IJUJ C449,11(Ll 01/AT - IVA It I I 12LC1f) I ft I #C�0� W
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/--/ FIRE REVIEWED BY
CITY ZIP TELEPHONE
-/-4-- &.149 549001 .11�ZR P
BY DATE
r% �A A 11
DATE
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SfATE LICENSE NUMBER EXPIRATION DATE
0
C CKED BY
VARIANCE OR CU
SHORELINE OR ADB#
I INSPECTION
REO'D
13 YES 0 NOI
SEPA
COMPLETED I EXIMPT
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06
CA# ftf 160
WAIVER
STUDY E3
ZON77SIGN
FL 5
AREA
ALLOWED I PROPOSED
N A-
HEIGHT
ALLOWED PROPOSED
I 2,E; 2-4 .13'
PROPERTY TAX ACCOUNT PARCEL NO,
714.1101 nz;
*2 '4 1 3 /
CRINEW Ey"RESIDENTIAL 51010 'PLUMBING MECH
ADDITION COMMERCIAL COMPLIANCE OR
1:1 1:1 CHANGE OF USE
E3 MIXED USE
REMODEL
MULTIFAMILY E] SIGN
FENCE
REPAIR CYDS ( , X FT.)
OTHER
DEMOLISH TANK
� ARAGE RETAINING WALL FIRE SPRINKLER
PC
�CAR RT ROCKERY FIREALARM
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
-FRONT _tffk_��
10' 3 11 -4-51 cl I
PARKING
REa'D PROVIDED
I— I
LOTAREA
PLANNING REVIEWED BY DATE
D 15 D 2,/ CE—
REMARKS
VVoLt Lz:�/�v
(TYPE OF USE, BUSINESSOR ACTIV!M,_t)�ELAIN:,_-?
TYPE OF ION
NUMBER NUMBER OF I'M
OF DWELLING SPECIAL INSPECTION
STORIES 4;z NITS REQUIRED I 13YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
q0" 0 STRUCT
BY.
VALUATION
$ cQ:;; 171 (0zo
Description
Plan Check
HEAT SOURCE LOT SLOPE77 VESTED DATE Building Permit
PLAN CHECK NO: Plumbing
C Tlf�/
OCCUPANT
GROUP
CONSULTANT
OCCUPANT
LOAD
:��
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
MAI ew
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT. SEE ECDC 119.00.005(A)(6).
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
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
Landscapelnsp.
INOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
ecording F
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT,AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
4
CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
F771-10220
�INYION INSURANCE AND RCW 18:27.
WORKMEN'S C^
(425)SIGNAT
3 W R AGENT):
DATE SIGNED
AT T FAN"ITION 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 I IRC110.
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
_^ ZIN
Plan Chk. Deposit
Receipt #
Total Amt. Due 136)
I Receipt #
APPLICATION APPROVAL
This application is riot a permit until signed by the
Bulding Official or his/her Deputy and Fees are paid, and
receipt is ackno�j'ledgcd in space provided
4,-I*_SjSIGNATURE I ) DATE
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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ORIGINAL -FILE - YELLOW -INSPECTOR
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Height Calculation Wor'ksheet
Date. 4-
Permit.Number C*-5- 1,(�� to I
Address 947 Aktk-
Inspector
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Average Grade 9
Max Height (25'+Ave.)
Actual Height (A+B+C) I a�L, 010
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