20051085A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS I
.� Jl �' �J VEL" ••—T U f` `r
MAILING ADDRESS r
CITY ZIP TELEPHONE
NAME
ADDRESS
[PERMIT EXPIRES 5::jI
'
PERMIT
NUMBER
JOB� 41; SUITF.IAPT#
ADDRESS
t
PLAT NAME/SUBDIVISION NO. LOT NO LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required E3
EXISTINGStreet Use Permit Requited 0
PROPOSED _ Inspection Required 0.
Sidewalk Requited
REQUIRED DEDICATION FT Underground O
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES E3 N013
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION. CONTROUDRAINAGE
NAME• CBL#
ENGINEERING REVIEWED BY DATE
ADDRESS
S(age
� FIRE REVIEWED BY DATE
CITY. / IP� TELEPHONE LL
ATE LICENSE NUMBER EXPIRATION ATE ECKED Y VARIANCE OR CU SHORELINE ORADBN INSPECTION SEPA
NS `_ � � �� )C � REQ'D COMPLETED EXEMPT
//I /// 0 YES E NO x
PROPERTY TAS( ACCOUNT ARCEL NO. ^ CAN ZONE SIGN AREA HEIGHT
/rr I 7� w J� WAIVER O (� ALLOWED PROPOSED ALLOW' D PROPOSED
!LIQ ` (%� STUDY I �+'
❑ NEW RESIDENTIAL ❑ PLUMBING / h1ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SID. _E` REAR FRONT tt)lw REAP; _
❑ COMMERCIAL COMPLIANCE OR jJ5 •/. .J C /.§ C IV
❑ ADDITION ❑ CHANGE OF USE 7 / 5 ! y Z
❑ MIXED USE PARKING LOTAREA PANNING REVIEWED BY DATE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED 11)
GRADING
1/� I 1 I �G
❑ ❑ GRADING ❑ FENCE ` .� / 1
REPAIR CYDS
( X FT.) REMARKS
❑ DEMOLISH ❑ TANKGARAGE �OT RI J Imo.
❑ CARPORT ❑ ROCKERY INING WALL ❑ FIREA ARM FIRE LER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: ,
r \ t TYPE OF C RUCTION 0 OCCUPANT
Li NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
j STORIES UNITS ' LOAD
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS r,
z
- - Q
YL af+GEOTECH REPORT m
BY: STRUCTURAL DESIGN
BY:
VALUATION
$ JU71
Description FEE Description FEE
Plan Check State Surcharge 0
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: i- Plumbing Base Fee
c 24
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THId PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
f DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL, REQUIRE Grading
t SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
CL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) '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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # a7 !
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE CJ
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due J
i NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt # C3C7
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
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application s/ not a permit until signed the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED. Building Official a Deputy: and Fees are p paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged n space provided
WORKMEN'S COMPENSA URANCE AND RCW 18:27,
O IC L SIGNATUR DATE
S U E(OW RAGENT): DATE SIGNED (42n5) �_71—D
U 771 W1/22 R L S Y/ DATE
ON EXT. 1333
IT IS UN FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL \� ol
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110, oRIGI AL -FILE Y LLOW -INSPECTOR
PI OWNER OLDD •ASSESSOR
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