20051091 (2).pdfDATE RECEIVED I\ U I � 0415
PERMIT EXPIRES
CITY OF EDMONDSt
BER o�(�
CONSTRUCTION PERMIT APPLICATIOSUITE/APT#
ADDRESS + V �
7
OWNER NAMEINAME OF BUSINESS j �11C: `S4
Q [ Ah1E/SUBDIVISION NO, LOT N LID NO.
W
MAILING ADDR SS 1 1� b LID FEE 5
3 RIGHT OF WAY PER OFFICIAL STREET MAP 1EscP npprovaf ❑
O 3 bCA-. _r C) N S RW Permit Requited ❑
Street Use Permit Required ❑
CITY ZIP TELEPHONE G PROPOSED Inspection Requited ❑
sidewalk Rngwred ❑
FV MOA) N S C1 �1`Z0 �� 3 Undargrou it ❑V UU lJ 1�RED DEDICATION FT Wmn ro tined ❑NAME R SIZELINE SIZE NO. OF FIXTURES PRV REQUIRED
YES[ NO0U
= ADDRESS KS w
R/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE _
Q W
CITY ZIP ITELEPHONE 11
NAME j l CBL#) l
r 1 1' 1/� O�� �5 �CC 7 O`Z S �/ 0 r ENGINEERING REVIEWED BY DATE
rY ADDRESS
5 9 - tod I lalv +k 51—
99 FIRE REVIEWED BY DATE w
OCITY ZIP TELEPHONE or
et 15 LL
STATE LICENSE NUMBER EXPIRATION ATE C KED B VARIANCE R CU SHORELINE OR ADB# INSPECTION SEPA
r REQ'D COMPLETED EXEMPT
• a r �. .q�f5- V -- �o �— 113YES NO X
Q PROPERTY TAX ACCOUtJT PARCEL NO. CAH Q6 � I-ff57 ZONE SIGN AREA HEIGHT
U WAIVER 0 n !— ALLOWED PROPOSED ALLOWED PROPOSED
09 3 �i�i0 O On STUDY 0 F -'S W 7y51 <Z51
❑ NEW RESIDENTIAL El PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
❑ COMMERCIAL COMPLIANCE OR �j i N C (�{'��� , z
��- ❑ MIXED USE 1:1CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL CL
CL
❑ ❑ MULTIFAMILY 1:1 SIGN REQ'D PROVIDED (alp D D 1, l , �.t�
REPAIR ❑ GRADING ❑ FENCE M N
v �; �'6Lwti^
CYDS ( X FT.) REMARKS
❑ DEMOLISH El TANK %9OTH C/W
CARPORT GARAGE ❑ ROCKERY RETAINING WALL 1:1 FIRE FIRE SPRIN LER b y 1 t
Lt/m e/
_ ❑
a(TYPE OF USE, BUSINESS OR A TIVITY) EX LAIN:
l TYPE O CO UCTION GROUP NT- E^'�
U) NUMBER NUMBER OF �. J1
O OF�7 DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES 5 f I I CZ UNITS I - REQUIRED YES LOAD
DE CRIBE WORK TO BE DONE ``
1 C A e(_C ssCtf REMARKS _
o
-��C ��L GEOTECH REPORT m
BY:
. - STR11G•TIJRAI nccrr_r.,
VALUATION I
$,tvvong
i Desc iption FEE Description FEE
uo •z> oa fj Plan Check a State Surcharge 4,150
HEAT SOURCE LOTS VESTED DATE.
U Building Permit City Surcharge
PLAN CHECK NO:Plumbing Base Fee 5
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL. REQUIRE g
i SEPARATE PERMISSION. Engr. RBVIBW
Lu
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
I
n '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
f 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 COMPENSATI RANCE AND RCW 18:27. F ALS SIGNAT E DATE
SIGNATOR WNER R NT): DATE SIGNED (425) �y I
1 Q Q �— 771-OZZd RE S AT
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- RIGINAL -FIE •YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110, JPINK -owN GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COP, S
Z
0
M
_
cm
M
-� O
O 0
c
M
M
IO
C Z
r =
O all
23
mm.
vN
Or=
n m
C fn 1
K W
t Z n
-'I m
M
I �
i D
f Z
2
0)
Z
O
0
M
i
t
-
RECEIVED s S'. 3 0
A py; i
�,
};
-1?A'k..A-_CC:ou�t: _._I _ U_ Al3v o -?_W 0,_9300.
I y. �.-
0Ic ;1 0 ,7005 I j !
_- i
DEVELOPMENT SERVICES CTR
CITY OF EDMONDS
opy
1 I
I
' I
.. & A i
i fx,� 1. I L �' -'
- f
.._i -. (rt_71S7
f l - i I I �.. .. �. + ! .. f _ 1 } . i_- } ,✓. I. i rl j' �� l k. , ._.� . �r yo ,t i r4
• r
0 I.
--
I
I
ov
l � � .- � c 4� i.o
1 L� i..
BUIL INCi' DE ,ARTMEN7 , I i } v m
I I
G1'TY-o E NDS , , --� }.. -, .. _.�_ .. I "_ ..-i---_+l� �__..._1_ !_ -� ...I_O ? C C
k }- - ... �� -- m
1
t I Ia 13r I r
_ -
ve
i i i I L n
i I
I
t
QZ
i—
mml -
j I j7l I ��Lc_ j j z
I R •I i I i j
1 h-- I I i f ------I m m
co)_
�/�i I-
Calm
Z.
a I _
ivi1�Y1
II ,
l I 1. Na.C,p,�_.p .�. �_: I I. �_ o
I
0
v I
m
i + !Fy , iy �u U)f�
I
I
In
-►-1 r I �j 1
_._ I- ..... j. -oGl �x
}_ � MMi 1
I I i iJj
i i�1 c I 1 I- I -N-
tl�i c f I ; � ,
;." ,n
1
�VED �YIPLANNIN.__
I.
._o ,
'I -r e
I
, I � s i
j
TibP A w cA e NI, e4 e ✓' j
' I _