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20051061A.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNERNAMEINAME OF BUSINESS JeOZ w MAILING ADDRESS V„£. CITY ZIP TELEPHONE NAME F- �U�utt t ADDRESS ' � I PERMIT EXPIRES P MIT i NUMBER`zz JOB l l i o'? OGd:�itN �Y SUITEIAPT# ADDRESS !E"D 1-t 'J PLAT NAME/SUBDIVISION NO.. LOT NO LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑ ❑ RW Permit Required Street Use Permit Required ❑ EXISTING PROPOSED Inspection Required ❑ __ _ Sidewalk Required ❑ REQUIRED DEDICATION FT • Underground Weinrequired E3 ❑ METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13NO ❑ c� _ tY W REMARKS w z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE u z W NAME / CBL# _.... 01401"11 will Ilr1317CU I um ENGINEERING REVIEWED BY DATE o AD RES' ACCEPTED U FIRE REVIEWED BY DATE CITY ZIP TELEPHONE O a U STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA REQ'D COMPLETED I EXEMPT 113YES L7 NO CA# ZONE SIGN AREA HEIGHT j PROPERTY TAX ACCOUNT PARCEL NO. - , i WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED U STUDY ❑ NEW RESIDENTIALPLUMBING / MECH. LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7 ❑ COMMERCIAL COMPLIANCE OR _ ❑ ADDITION ❑ CHANGE OF USE Z ❑ MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE 5 ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED ❑ REPAIR ❑ GRADING CYOS ❑ (FENCEX FT.) REMARKS DEMOLISH ❑ TANK ❑ OTHER _ ❑GARAGE RETAFIRE CARPORT ❑ ROCKIERY NING WALL ❑ FIREA ARM SPRINKLER I a (TYPE OF USE, BU INESS A TIVITY) HXPAI i TYPE F TRUCTJON COPE . 22 OCCUPANT U w NUMBER BER OF C OF DWELLING SPEfCIALINSPECTtONCONSULTANT - OCCUPANT M STORIES UNITS - - LOAD -r REQUIRED D YES DESCRIBE WORM E DON joilPoroC Flto o/ i 1`7iE-i j � REMARKS Z c o GEOTECH REPORT m n G BY: 6:4.5 STRUCTURAL DESIGN BY: 1011 Sk2T /L© f. VALUATION JAezwloDescription FEE Description FEE Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit City Surcharge PLAN CHECK NO: Plumbing 1 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 LE DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading i SEPARATE PERMISSION, I Engr. REVIEW W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) 5 E BACK OF PINK PERMIT FOR MORE INFORMATION EngG Inspection *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 W EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY = 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." Recording Fee Receipt # 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 This application Is not a permit until signed by the THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid, and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OF SI URE \ DATE SIG RE NE ENT): DATE SIGNED (425) 60 771 =0220 R A B 1 DA 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. UBC1091 IBC1101 IRC110. PINK -OWNER GOLD - ASSESSOR 10/04 PRESS HARD - YOU ARE MAKING 4 COPIES