20051087.pdfDATE RECEIVED
CITY OF EDMONDS
C CONSTRUCTION PERMIT APPLICATION
OWNER NAIAIEYNA� E OF BUSINESS
R
ON
w
INAE
17
wuj M?AILING ADDRESS
Z
62c) 7 A9
CITY ZIP TELEPHONE
7-79 ZOO
no
2
'ee'llno'706 P%-A L802-0
NAME
af%>tz uSA alzt,&fe /A/& 6
ADDRESS
3`EI7,i!� AV&
CITY zip ITELEPHONE .2
4S&A ITL, -7,66 g? "
STATE LICENSE NUMBER EXPIRATION DATE C55
�KED BY
PROPERTY TAX ACCOUNT PARCEL NO
El
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
USE
MIXED USE
CHANGE OF I
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
X FT.)
E]
DEMOLISH
E]
TANK
91
ER —
off, At, iz�44 r�
oGARAGE
RETAINING WALL
FIRE SPRINKLEfi
CARPORT
ROCKERY
FIREALARM
(TYPE OF UqE, BUSINESS OR ACTIVITY) EXPLAIN:
6. Ija g eA
NUMBER
OF
'21
NUMBEROF
DWELLING
STORIES
UNITS
lar
DESCRIBE WORK TO BE DONE
7
PERMIT
NUMBER
JOB
ADDRESS 'n 7
PERMIT EXPIRES 24 '9/
�7
t" SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LID NO.
_!D FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I LSCP Applo� on
E3
13
RVV Perma RN.d.wd
Sifeei Use Perm Requium
13
EXISTING PROPOSED
111SPC-Clion Retiuifed
C3
Sidebak Requtted
13
REQUIRED DEDICA1 ION ___ FT
Undelground
13
[3
Wmnq teciaaea
METER SIZE
LINE SIZE
NO. OF FIXTURES
PFIV REQUIRED
I
I
YES 13 NOO
REMARKS
Z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
rx
Lu
W
Z
0
na
BY
TE
Z
uj
FIRE REVIEWED BY
DATE
W
cc
VARIANCE OR CU
SHORELINEORADB#
INSPEEQCTION
SEPA
R D
COMPLETED EXEMPT
C3 YES 13NO
I
CA#
ZONE
SIGN AREA
HEIGHT
OWAIVEIR
I
ALLOWED PROPOSED I
I
ALLOWED
PROPOSED
STUDY
I
I
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
Z
PARKING
LOT AR
EVIEWED BY DATE
REO D i PROVIDED
REMARKS
CONSTRUCT12N OCCUPANT
1 GROUP
CONSULTANT
REQUIRED DYES
V' REMARKS
GEOTECH REPORT
BY!
STRUCTURAL DESIGN
BY.
+ f VAtV
$ i�
Itm Description
V V.�
HE�ISOUR E LO S OtE% VESTED DATE Plan Check
Til� 4A Building Permit Oil!
7_LAN CHE(;k NO: L
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
j Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE,HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
I THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT
Y ORDINANCE
C NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Landscapeinsp.
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 CALL
'n��
'Y 0
E P R
RD
0
INFO R N AN
to
V'S N
M ATION
E D AGENT 0 F
G C 0 N STRU C
r M
_ P Y
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATIN 'j
G CONSTRUC_
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND'PqW 18;47")
'ff 1 (425)
SI�NA (OWNER OPfAGCNT,?� A/ I'DATE SI NED 771-0220
74 EXT. 1333
7
OCCUPANT
LOAD
FEE Description
State Surcharge
�z City Surcharge
Base Fee
ATTENTION ' I
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 / IBC110 / IRC110.
FEE
164729
1.�'
Recording Fee
Plan Chk. Deposit
Receipt N
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hiSther Deputy, and Fees are paid. arid
T, COpt is acknowledged in space provided
OF SIGI A IRE DAT
AjLEWEb'BY bATE
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
a
Z
Z
0
A
0
M
-n
0 M
C
M
0
10
0 C:
M
M Z
C
>
0 _T1
M M
0
0
0 M
cl)
CO)
Q 0
Z
X
X
Z
Z
0
0
M