20051097.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILINUGADDRESS
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CITY TELEPHONE
NAME
ADDRESS
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ADDRESS
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CITY ZIP
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STATE LICENSE NUMBER
Rni-VICANAt-
Vp'lt- 01?aM%�
PROPERTY TAX ACCOUNT PARCEL NO.
CBL#
9
TELEPHONE
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EXPIRATION DATE CHECKED BY
NEW
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RESIDENTIAL
ADDITION
20"COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAG E
CARPORT
RETAINING WALL
ROCKERY
TYPE OF USE Rl i'zi"cc nO ACTIVITY) EXPLAIN
E] PLUMBING ir MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT.)
OTH E
EFIRE SPRINKLER
IFIRE ALARM
PERMIT EXPIRES L/,', �`
PERMIT
NUMBER
JOB
ADDRESS
/SUITEIAPTri
51 c5uk-;
PLAT NAMEISUBDIVISION NO.
7
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
13
13
RW Permit Required
Street use Permit Requited
0
EXISTING PROPOSED
inspection Required
E3
Sidewalk Requved
0
REQUIRED DEDICATION
FT
Undieground
Witinq required
0
13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NOM
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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141
ENGINEERING REVIEWED BY DATE
ED BY DATE W
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VARIANCE OR CU SHORELINE ORADB,1 I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
13 YES 13 NO I
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED I PROPOSED ALLOWED PROPOSED
STUDY 13
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOTAREA LANNING REVIEWED BY DATE 5
REO'D . PROVIDED I rp 1 116
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NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
. I' �_R �" r
SPECIAL INSPECTION
REQUIRED 13YES
DESCRIBE WORK TO BE D07E
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REMARKS
I CODE
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CONSULTANT
GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
HEAT SOURCE
LOTSLOPE%
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VESTED DATE
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Building Permit
PLAN CHECK NO,
Plumbing
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.$
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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
WORKMEN'S COMPENSAT103AHRRANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771-0220
SIGNATURE (OWNER OR NT):
DATESIGNED
ATTENTION `k.� I 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110.
FEE
OCCUPANT
GROUP x
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
I I Plan Clik. Deposit
FEE
Receipt ft
Total Amt. Due
,
Receipt #
APPLICATION APPROVAL
This application is not a pormit until signed by the
Building official or his/her Deputy and Fees are paid, and
receipt is acknowledged in spacoproviclud
FIPIALS SIGNATURE DATE
W
LEAjfLYfY DAT E
It 0104 . PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSF-C-CTC
PINK -OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE_�--�_?
P.LEASH SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
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PLANNING DIVISION DATE
PLEASE SIGN
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PROJECT '21:Lys z)
SITE ADDRESS 2e�2 2,- S
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PERMIT # b? 7 DATEINSPECTED 13 —6a
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DESCRIPTION OF WORK TO BE INSP I)1�2�Z
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes �that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS 'iven to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Cop of CORRECTION NOT ICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDI-NG ISSUES - GRANT FINAL PROJECT APPROVAL
Datc Signattire
1:tem1):b1dg:rorms:ocaprv1 3/25/04