20051064.pdfi
DATE RECEIVED
[PERMIT , EXPIRES
JA
ERMIT
CITY OF EDMONDS UMBER S--
CONSTRUCTION PERMIT APPLICATIONB SUITEIAPTn
OWNER NAME/NAME OF BUSINESS DRESS ld r / ezo �j � 1 %
r l L[J L
AT NAMESUBDIVISION NO LOT NO. LID NO
MAIL NGtArDDRESS ^ LID FEES
PL BLIC RIGHT OF WAY PER OFFICIAL STREET MAP ILSC13Appro.r•a
'v 1 HW Perms nenurtea
Street Use PernLl Requnea
CITY �I♦' A GZIIP(�//�� TELEPHONE ISTING PROPOSED Inspect,nnRequ.rea
EQUIRED UEUICAI ION —`---• —_----- FT ---_-'_-- Undcrq Oona
regdrea
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRVREQUIRED
YESO NO OADDRESS EMARKS
WNF.RiCONTHACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
T
0
z
W
W
z
u
z
W
NAME CBLp ENGINEERING,I• -
UAIt
qyT37Pe 33 or -a •vent co
ADDRESS / RECYCLE REJOUD-ft.1-`lI� C1irI� BP�i]IAl1CCS passiell
ng
90
<3 lop V ��1ti-P/.1-�� S th roe h u njI e
CITY80
ZIP TELEPHONE PUBLIC WOR 3fifrV16WWlEiY.�.,a
SA!�gill iia 7 a—� 5 �"
STATE LICENSE NUMBER EXPIRATION D TE CH D BY FIRE REVIEWED BY DATE u
3:X= ��
VARIANCE OR CU SHORELINE OR AOBa INSPECTION SEPA
PROPERTY TAX ACCOUNT PARCEL NO. REQ'D COMPLETED EXEMPT
1s- d . O YES ONO
v Cqq ZONE SIGN AREA HEIGHT
❑ NEN/ RESIDENTIAL PLUMBING I MECH ❑ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
COMMERCIALCOMPLIANCE OR 13 STUDY
❑ ADDITION ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ MIXED USE ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑
EPAIR GRADING FENCE CYDS ❑ ( X FT.) PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D PROVIDED
OTHER
LJ DEMOLISH ❑ TANK ❑ I
GARAGE RETAINING WALL FIRE SPRINKLER REMARKS
❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE OF USE, BUSINES O$ R�IVITY) EXPLAIN:
NUMBER P$ OI
NUMBER OF
OF DWELLING TYPE =NN D OCCUPA
STORIES UNITS GROUP
DESCRIBE WORK TO BE DONE
SPECIAL INSPECTION CONS TANT OCCUPANT
LOAD
A _ _ REQUIRED D YES
.S BY:
/ IVIS STf
BY•
�rr Description FEE Description FEE.
H T S URCE a/LOT SLOPE06 (, VESTED DATE Plan Check State Surcharge
PL CHECK NO: Building Permit City Surcharge
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engf. R@VI@W Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection Plan Chk. Deposit
w•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
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.. Duo -�
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
o DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.• Landscape Insp. Receipt N
i
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 CALL This application is not a permit until signed by Ino
THE OWNER, I AGREE TO COMPLY WITH CITY &S7TE LAWS REGULATING CONSTRUC• Building Olhcial or hismer Deputy and Foos ate paid and
TION; AND IN DOING THE WORK AUTHO TH BY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is ac lodged i space provided
IN WORKMEN'S CO ON F THE LABOR D ANCE TH RCW 16: OF WASHINGTON RELATING TO (425) OFF L TUI E DATE
SIGN A E (OWNER O A NT): DATE SIGNED / 771=0220
L RELEASE B LATE
EXT. 1333
A NTI N
IT IS UNLA UL USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL S TION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL • FILE YELLOW • INSPECTOR
FICATE CCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK • OWNER GOLD • ASSESSOR
6/05 PRESS HARD = YOU ARE MAKING 4 COPIES
1